【作者】 任娜；

【导师】 唐芳；

【作者基本信息】 山东大学 ， 护理学， 2024， 硕士

【摘要】 目的调查胃肠肿瘤患者全身麻醉术后寒战反应的发生现状,探讨寒战反应发生的危险因素,构建胃肠肿瘤患者全身麻醉术后寒战反应的列线图风险预测模型并对其进行评价,旨在提高临床医护人员对全身麻醉术后寒战反应的重视程度,为临床医护人员有针对性地识别高危人群、制定相应干预措施及预防术后寒战反应的发生提供一定的依据。方法选取2021年12月1日～2023年9月30日在山东省某三甲医院全身麻醉下行胃肠肿瘤手术的308例患者为研究对象,编制《胃肠肿瘤患者全身麻醉术后寒战相关因素信息收集表》,借助医院信息系统以及床旁访视完成相关临床资料的收集。将所收集的数据采用7:3随机拆分的方法分为训练集(216例)和测试集(92例),分别用于构建和验证风险预测模型。将发生寒战反应的患者纳入寒战组,未发生寒战反应的患者纳入非寒战组,采用单因素分析对胃肠肿瘤患者全身麻醉术后寒战的危险因素进行初步筛选,使用多因素Logistic回归分析术后寒战的危险因素,建立风险预测模型并绘制列线图。使用ROC曲线下面积(AUC)评价预测模型的区分度,使用校准曲线及Hosmer-Lemeshow检验评价模型的校准度及拟合度,评估预测模型的准确性。结果1.本研究共纳入308例在全身麻醉下行胃肠肿瘤手术的患者,其中男性206例(66.88%),女性 102 例(33.12%),平均年龄为 63.99±11.03 岁。训练集(n=216 例)患者平均年龄为63.81±11.25岁,其中男性144例(66.67%),女性72例(33.34%);测试集(n=92例)患者平均年龄为64.41±10.54岁,其中男性62例(67.39%),女性30 例(32.61%)。2.本研究共计75例胃肠肿瘤患者全身麻醉术后发生寒战反应,发生率为24.35%。寒战的分级以2级和3级居多,分别为27例(36.00%)和34例(45.33%)。3.本研究经Logistic回归分析,得出胃肠肿瘤患者全身麻醉术后寒战反应的影响因素:手术方式、液体输入量、入麻醉后恢复室(Postanesthesia Care Unit,PACU)中心体温和术后视觉模拟评分法(Visual Analogue Scale,VAS)评分。4.基于以上变量构建的风险预测模型训练集和测试集的AUC分别为0.731和0.726,Hosmer-Lemeshow检验结果P值分别为0.818和0.578,说明构建的模型具备良好的区分度和校准度。结论1.全身麻醉下接受胃肠肿瘤手术治疗的患者术后寒战反应仍存在一定的发生率,且以2级和3级寒战为主。2.腹腔镜手术、液体输入量大、入PACU低体温、术后疼痛是胃肠肿瘤手术患者全身麻醉术后寒战反应发生的独立危险因素。3.基于以上变量构建的风险预测模型区分度和校准度良好并有良好的预测能力。模型可视化后所绘制的列线图可应用于临床并为临床决策提供参考。更多还原

【Abstract】 ObjectiveTo investigate the occurrence status of postoperative shivering in gastrointestinal tumors surgery patients after general anesthesia,explore the risk factors of postoperative shivering,construct and verify a nomogram risk prediction model for postoperative shivering in patients with gastrointestinal tumors after general anesthesia.The aim is to improve clinical medical personnel’s attention to postoperative shivering in general anesthesia and to provide a certain basis for the nurses to identify the high-risk groups,formulate corresponding interventions,and prevent the occurrence of postoperative shivering.MethodsWe included 308 patients undergoing gastrointestinal tumors surgery after general anesthesia in a Grade A hospital in Shandong Province from December 1,2021 to September 30,2023.In this study,we used the self-designed "Questionnaire on Factors Associated with Postoperative Shivering in Gastrointestinal Tumors patients Undergoing General Anesthesia"to collect relevant clinical data with the help of the hospital information system and bedside interviews.The collected data were randomly divided into a training set(216 cases)and a validation set(92 cases)using a 7:3 random splitting method,the data was used to construct the risk prediction model,and the validation set was used to validate the model.In the training set,patients with postoperative shivering were included in the shivering group,and those without shivering were included in the non-shivering group.The risk factors for postoperative shivering after general anesthesia in patients with gastrointestinal tumors were preliminarily screened by using one-way analysis,and multi-factorial logistic regression was used to analyse the independent risk factors and to construct a risk prediction model and to draw the Nomogram.AUC was used to evaluate the discrimination of the predictive models,and the calibration curve and the Hosmer-Lemeshow test were used to evaluate the calibration and fit of the models and assess the accuracy of the prediction models.Results1.A total of 308 patients with general gastrointestinal tumors anesthesia were included,of whom 206(66.88%)were male and 102(33.12%)were female,and the mean age of the operated patients was 63.99±11.03 years.The mean age of patients in the training set(n=216 patients)was 63.81 ± 11.25 years,of which 144(66.67%)were male and 72(33.34%)were female,and the mean age of patients in the test set(n=92 patients)was 64.41±10.54 years,of which 62(67.39%)were male and 30(32.61%)were female.2.In this study,75 patients with gastrointestinal tumors experienced shivering after general anesthesia,with an incidence rate of 24.35%,the grading of shivering was most frequent in grade 2 and grade 3,27(36.00%)and 34(45.33%)cases,respectively.3.In this study,four variables were identified as independent risk factors for shivering after general anesthesia in patients with gastrointestinal tumors:the type of surgery,liquid input,admission to the Postanesthesia Care Unit(PACU)core temperature,and postoperative VAS score.4.Based on the above variables,the AUCs of the training set and validation set of the constructed risk prediction model are 0.731 and 0.726,and the P-values of the Hosmer-Lemeshow tests are 0.578 and 0.818,respectively,which indicates that the constructed model has good differentiation and calibration.Conclusion1.Postoperative shivering in patients undergoing gastrointestinal tumors surgery under general anesthesia are still present and are predominantly grade 2 and 3 shivering.2.Laparoscopic surgery,large liquid input,hypothermia during awakening,and postoperative pain are independent risk factors for the occurrence of shivering after general anesthesia in patients undergoing gastrointestinal tumors surgery.3.The risk prediction model constructed based on the above variables has well discrimination and calibration,and also has good predictive ability in the validation set.The Nomogram drawn after the model visualization is expected to provide a reference for clinical decision making.更多还原