| 摘要: |
| 目的 探讨行达芬奇机器人辅助腹腔镜胰腺癌根治手术的患者发生术后意外低体温（UPH）的危险因素，构建风险预测模型并评价其预测效能。方法 选取2020年12月至2021年12月在海军军医大学（第二军医大学）第一附属医院接受达芬奇机器人辅助腹腔镜胰腺癌根治手术的患者作为研究对象，根据UPH的发生情况将患者分为UPH组和非UPH组。比较两组患者的一般资料（年龄、性别、美国麻醉医师学会分级、BMI、术前血红蛋白、术前白蛋白、基础体温）、手术资料（手术方式、神经阻滞类型、麻醉时间、手术时间、人工气腹建立时间、术后体温、术后并发症、院内转归）、围手术期液体管理资料（晶体液、胶体液、红细胞悬液、新鲜冰冻血浆、失血量、尿量）。采用logistic回归方法构建UPH预测模型，绘制ROC曲线和决策曲线评价模型预测UPH的效能，并建立列线图模型。结果 共纳入患者246例，其中117例（47.6%）发生UPH。两组患者的BMI （P=0.047）、术前血浆白蛋白水平（P=0.038）、术后肺部并发症（PPC，P=0.039）、非肺部术后感染（NPPI，P=0.018）、总住院时间（P=0.001）、手术方式（P=0.042）、手术时间（P=0.038）、术中人工气腹建立时间（P=0.004）、神经阻滞类型（P=0.004）、术后体温（P<0.001）比较差异均有统计学意义。logistic回归分析结果显示达芬奇机器人辅助术式（OR=9.369，95%CI 2.528~34.717，P=0.001）、BMI （OR=0.787，95%CI 0.687~0.902，P=0.001）、手术时间（OR=0.040，95%CI 0.009~0.183，P<0.001）、人工气腹建立时间（OR=15.608，95%CI 3.814~63.870，P<0.001）、输液速率（OR=0.808，95%CI 0.706~0.924，P=0.002）、输液总量（OR=3.431，95%CI 1.480~7.956，P=0.004）及神经阻滞类型（OR=0.240，95%CI 0.131~0.443，P<0.001）与UPH的发生具有独立相关性。ROC曲线的AUC值为0.739，预测发生UPH的灵敏度为0.778，特异度为0.628。决策曲线分析结果表明预测模型具有较好的临床净收益。结论 BMI低、输液速率慢、输液总量大、椎旁神经阻滞、胰十二指肠切除术、手术时间长、人工气腹建立时间长是达芬奇机器人辅助腹腔镜胰腺癌根治手术患者发生UPH的危险因素，根据上述因素构建的风险预测模型效果较好。 |
| 关键词: 胰腺肿瘤 机器人辅助腹腔镜胰腺癌手术 手术后意外低体温 手术后并发症 麻醉 危险因素 |
| DOI：10.16781/j.CN31-2187/R.20230537 |
| 投稿时间：2023-09-25修订日期：2023-12-13 |
| 基金项目:海军军医大学（第二军医大学）第一附属医院“234学科攀峰计划”（2019YXK022）. |
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| Influencing factors of unexpected postoperative hypothermia in patients undergoing da Vinci robot-assisted laparoscopic surgery for pancreatic cancer |
| NIU Ting1,LU Liangliang2,LI Jialin2,XU Tao2,DAI Yuanqiang2* |
(1. Operating Room, Department of Anesthesiology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China;
2. Department of Anesthesiology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the risk factors of unexpected postoperative hypothermia (UPH) in patients undergoing da Vinci robot-assisted laparoscopic surgery for pancreatic cancer, construct a risk prediction model, and evaluate its prediction efficacy. Methods Patients who received da Vinci robot-assisted laparoscopic radical surgery for pancreatic cancer in The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Dec. 2020 to Dec. 2021 were enrolled. According to the development of UPH, the patients were divided into UPH group and non-UPH group, and the general data (age, gender, American Society of Anesthesiologists classification, body mass index [BMI], preoperative hemoglobin, preoperative albumin, and basal body temperature), surgical data (operation mode, type of nerve block, anesthesia time, surgical time, artificial pneumoperitoneum time, postoperative body temperature, postoperative complications, and in-hospital outcomes), and perioperative fluid management data (crystal fluid, colloid fluid, red blood cell suspension, fresh frozen plasma, blood loss, and urine volume) were compared. Logistic regression was used to construct a UPH prediction model, receiver operating characteristic (ROC) curves and decision curves were drawn to evaluate the effectiveness of the model in predicting UPH, and a nomograph model was established. Results A total of 246 patients were enrolled, of whom 117 (47.6%) developed UPH. There were significant differences in BMI (P=0.047), preoperative plasma albumin (P=0.038), postoperative pulmonary complications (P=0.039), non-pulmonary postoperative infection (P=0.018), total length of stay (P=0.001), operation mode (P=0.042), operation time (P=0.038), intraoperative of artificial pneumoperitoneum time (P=0.004), type of nerve block (P=0.004) and postoperative body temperature (P<0.001) between the 2 groups. Logistic regression analysis showed that da Vinci robot-assisted surgery (odds ratio [OR]=9.369, 95% confidence interval [CI] 2.528-34.717, P=0.001), BMI (OR=0.787, 95% CI 0.687-0.902, P=0.001), operation time (OR=0.040, 95% CI 0.009-0.183, P<0.001), artificial pneumoperitoneum time (OR=15.608, 95% CI 3.814-63.870, P<0.001), fluid infusion rate (OR=0.808, 95% CI 0.706-0.924, P=0.002), total fluid infusion (OR=3.431, 95% CI 1.480-7.956, P=0.004) and the type of nerve block (OR=0.240, 95% CI 0.131-0.443, P<0.001) were independently correlated with the development of UPH. The area under curve value of the ROC curve was 0.739, with a sensitivity of 0.778 and a specificity of 0.628 for predicting UPH. The decision curve analysis results indicated that the predictive model had good clinical net benefits. Conclusion Low BMI, slow fluid infusion rate, large total fluid infusion volume, paravertebral blockade, pancreaticoduodenectomy, long operation time, and long artificial pneumoperitoneum time were the risk factors of UPH in patients undergoing da Vinci robot-assisted laparoscopic radical surgery for pancreatic cancer. The risk prediction model constructed according to the above factors has good effect. |
| Key words: pancreatic neoplasms robot-assisted laparoscopic surgery for pancreatic cancer unexpected postoperative hypothermia postoperative complications anesthesia risk factors |
