择期手术患者术后恶心呕吐危险因素分析及临床预测模型构建
Analysis of risk factors for postoperative nausea and vomiting in patients undergoing elective surgery and establishment of clinical prediction model
刘昕 1朱小宁 1田碧芸 1李艳 1顾英花 1叶青山1
作者信息
- 1. 宁夏回族自治区人民医院麻醉科,宁夏银川 750002
- 折叠
摘要
目的 探讨择期手术术后恶心呕吐(PONV)的危险因素,建立预测择期手术PONV发生的临床列线图模型.方法 收集1 093例择期手术患者的临床资料,通过单因素分析和多因素回归得出PONV发生的独立危险因素,并将危险因素通过R语言绘制列线图.对临床预测模型进行Bootstrap内部验证与校正,诊断效能使用受试者工作特征曲线(ROC)评价.结果 133例患者出现PONV,发生率为12.2％.女性(OR=2.070,95％CI:1.143～3.747)、晕动病史或 PONV 史(OR=60.760,95％CI:31.661～116.604)、术中低血压(OR=10.533,95％CI:5.182～21.411)、术后使用阿片类药物(OR=2.903,95％CI:1.667～5.056)、术后 VAS 评分＞3 分(OR=11.610,95％CI:6.362～22.221)是择期手术PONV发生的独立危险因素.ROC曲线下面积为0.922(95％CI:0.904～0.937),灵敏度为89.5％,特异度为84.2％,提示模型区分度良好.列线图模型内部验证校准曲线显示预测值与实测值曲线重合度良好.结论 择期手术PONV发生的独立危险因素有女性、晕动病史或PONV史、术中低血压、术后使用阿片类药物以及术后VAS评分＞3分.通过以上危险因素绘制的临床列线图预测模型区分度较好.
Abstract
Objective To investigate the risk factors of postoperative nausea and vomiting(PONV)after elective surgery,and establish a nomogram model for predicting PONV.Methods The clinical data of 1093 patients undergoing elective surgery were collect-ed,and independent risk factors were obtained through single and multi-factor Logistic regression analysis.The nomogram prediction model was constructed by using R language,and the model was internally verified and the diagnostic efficacy of the model was evaluated by making correction curve and receiver operating characteristic curve(ROC).Results PONV occurred in 133 patients(12.2％).Female(OR=2.070,95％CI1.14～3.747),history of motion sickness or PONV(OR=60.760,95％CI31.661～116.604),intraop-erative hypotension(OR=10.533,95％CI5.182～21.411),postoperative use of opioids(OR=2.903,95％CI 1.667～5.056),VAS＞3(OR=11.61,95％CI6.362～22.221)were independent risk factors for PONV.The area under ROC curve was 0.922(95％CI 0.904～0.937),the sensitivity was 89.5％,and the specificity was 84.2％.The calibration curve of the internal verification of the no-mogram model showed a good coincidence between the predicted value and the measured value.Conclusion Female,history of motion sickness or PONV,intraoperative hypotension,postoperative use of opioids,VAS＞3 are independent risk factors for PONV in elective surgery.The nomogram model has good clinical application value in predicting the occurrence of PONV.
关键词
术后恶心呕吐/危险因素/回归分析/临床预测模型/列线图Key words
Postoperative nausea and vomiting/Risk factors/Regression analysis/Clinical prediction model/Nomogram引用本文复制引用
基金项目
宁夏回族自治区重点研发计划(2022BEG03114)
宁夏回族自治区人民医院培育振兴科研项目(202012)
出版年
2024
NETL
NSTL
万方数据