Predictive model of postoperative hypotension in patients undergoing hepatocellular carcinoma resec-tion with controlled low central venous pressure
Objective To investigate the prediction model of hypotension in patients with hepato-cellular carcinoma resection using controlled low central venous pressure technique(CLCVP).Methods A total of 144 patients with liver cancer admitted from January 2020 to June 2023 were retrospectively ana-lyzed,including 81 males and 63 females,aged 45-64 years,BMI 22-26 kg/m2,ASA physical status Ⅰ or Ⅱ.144 patients were randomly divided into trial set(n=96)and verification set(n=48)according to 2:1.The trial set and verification set were divided into hypotensive group and non-hypotensive group ac-cording to whether hypotension occurred after operation.Preoperative albumin,preoperative hemoglobin,op-eration method,operation time,tumor site,tumor size,hilar block time,number of hilar block times,hilar block interval time,blood loss,mean intraoperative CVP,intraoperative fluid volume,and intraoperative u-rine volume were collected.Univariate and multivariate Logistic analysis were used to analyze the risk factors of hypotension in the experimental group,and a risk prediction model was established.The risk prediction model was verified in the validation group.Results There were 29 patients(30.2％)of postoperative hy-potension in the test group and 15 patients(31.3％)of postoperative hypotension in the validation group.Compared with the non-hypotensive group,the preoperative albumin in the hypotensive group was signifi-cantly decreased(P<0.05),the operation time was significantly prolonged,the ratio of tumor diameter≥5 cm,and the amount of blood loss were significantly increased(P<0.05).Multivariate analysis showed that preoperative albumin elevation(OR=0.216,95％CI 0.164-0.665,P<0.05)was an independent protective factor for postoperative hypotension.Prolonged operative time(OR=2.649,95％CI 1.802-7.553,P<0.05),tumor diameter≥5 cm(OR=3.789,95％CI 2.011-12.458,P<0.05),in-creased blood loss(OR=8.873,95％CI 2.750-17.553,P<0.05)was an independent risk factor for postoperative hypotension.According to the results of multi-factor analysis,the risk factors of postoperative hypotension in patients with controlled low central venous pressure hepatocellular carcinoma resection were established:F=-408.64-(1.534×preoperative albumin)+(0.974×operation time)+(1.332×tumor diameter≥5 cm)+(2.183×blood loss).The risk model was validated in the validation set,and the area under the ROC curve(AUC)was0.821(0.695-0.943),the sensitivity was71.7％,and the speci-ficity was 86.5％.The Hosmer-Lemeshow goodness of fit test showed that χ2=10.654,P=0.222.Conclusion Prolonged operative time,tumor diameter≥5 cm and increased blood loss are risk factors for hypotension after hepatocellular carcinoma resection using CLCVP technique,and higher preoperative albumin is protective factor.The establishment of risk prediction model through multi-factor analysis has good forecasting value.
Controlled low central venous pressureLiver cancerOperation timeTumor diameter
万方数据
维普
