口腔癌根治术患者术中低体温风险预测模型的构建及验证

目的 构建基于复合保温基础上口腔癌根治术患者术中低体温的风险预测模型并将其可视化呈现,评价模型临床应用价值。方法 选取2020年1—11月在南京市某口腔专科医院行口腔癌根治术的234例患者作为建模组,将低体温组（n=103）与非低体温组（n=131）之间进行危险因素比较,采用Logistic回归建立预测模型,区分度评价采用受试者操作特征曲线下面积检验,校准度评价采用Hosmer-Lemeshow拟合优度检验。于2020年12月—2021年2月选取100例患者作为验证组对模型应用评价。结果 共纳入年龄（OR=1.033）、BMI（OR=0.346）、基础体温（OR=0.338）、术中输液量（OR=2.320）、加温毯温度（OR=0.236）等5个因素构建预测模型。H-L拟合优度检验P=0.656,受试者操作特征曲线下面积为0.812,约登指数为0.530,灵敏度为0.767,特异度为0.763。结论 本模型在预测口腔癌根治术中低体温发生的效果良好,可为医护人员早期对高危患者采取预防性管理措施提供参考。

Construction of Risk Prediction Model for Intraoperative Hypothermia in Patients Undergoing Radical Resection of Oral Cancer and Its Validation

Objective To construct a risk prediction model for intraoperative hypothermia in patients undergoing radical resection of oral cancer based on various warming methods, to visualize the model and to evaluate its clinical value. Methods A total of 234 patients in a stomatological hospital of Nanjing were enrolled from January 2020 to November, and risk factors in hypothermia group (103 cases) and non-hypothermia group (131 cases) were compared and logistic regression was adopted for model construction. The discrimination of the model was evaluated by the area under the curve（AUC）. Model calibration was done by Hosmer-Lemeshow goodness-of-fit test. A total of 100 patients were selected as the validation group from December 2020 to February 2021 to evaluate the application value of the model. Results The factors entering the predictive model were age (OR=1.033), BMI (OR=0.346), basal body temperature (OR=0.338), intraoperative fluid infusion (OR=2.320) and heating blanket temperature (OR=0.236). The p-value in the Hosmer-Lemeshow goodness of fit test was 0.656; the area under the subject operating characteristic curve 0.812; Youden index 0.530; sensitivity 0.767; specificity 0.763. Conclusion The model is effective for predicting the occurrence of hypothermia during radical resection of oral cancer, which provides reference for medical staff to take preventive measures for high-risk patients in the early stage.