摘要
目的 基于Logistic评估剖宫产腰硬联合麻醉(CSEA)后低血压风险,并构建列线图预测模型。方法 回顾性选取2023年1月至2024年12月在广元市中心医院CSEA下行剖宫产的产妇125例,依据是否发生低血压分为低血压组(n=50),无低血压组(n=75)。收集入组患者年龄、胎位、身体质量指数(BMI)、孕周、胎儿体重、麻醉前输液量、产次、胎儿数量、麻醉后3 min内平面、护理干预方式资料。采用多因素Logistic回归分析影响剖宫产CSEA后低血压的危险因素。采用R软件构建预测剖宫产CSEA后低血压的列线图预测模型,并对预测模型进行验证。结果 低血压组BMI≥28 kg/m^(2)、多胎妊娠、麻醉后3 min内平面≥T_(8)的比率分别为76.00%、64.00%、68.00%,均明显高于无低血压组(42.67%、32.00%、28.00%),差异均有统计学意义(P<0.05);两组年龄、胎位、孕周、胎儿体重、麻醉前输液量、产次、护理干预方式等比较,差异均无统计学意义(P > 0.05)。BMI≥28 kg/m^(2)(OR=5.049,95%CI:1.806~14.114)、多胎妊娠(OR=9.738,95%CI:3.577~26.510)、麻醉后3 min内平面≥T_(8)(OR=7.966,95%CI:2.918~21.741)是影响剖宫产CSEA后低血压的危险因素(P<0.05)。列线图预测模型受试者操作特征曲线下面积为0.884(95%CI:0.820~0.948),区分度较优。结论 BMI≥28 kg/m^(2)、多胎妊娠、麻醉后3 min内平面≥T_(8)为CSEA后发生低血压的危险因素,据此构建的列线图预测模型,具有较好的区分度和一致性。
Objective To evaluate risk of hypotension after combined spinal and epidural anesthesia(CSEA)for cesarean section based on logistic,and a nomogram prediction model was constructed.Methods A total of 125 women who underwent cesarean section in Guangyuan Central Hospital from January 2023 to December 2024 were retrospectively selected,and 50 cases were divided into hypotension group and 75 cases without hypotension group according to whether hypotension occurred.The data of age,fetal position,body mass index(BMI),gestational age,fetal weight,infusion volume before anesthesia,parity,number of fetuses,plane within 3 min after anesthesia and nursing intervention were collected.Multivariate Logistic regression analysis was used to analyze the risk factors of hypotension after CSEA in cesarean section.A nomogram prediction model for predicting hypotension after cesarean section CSEA was constructed by R software,and the prediction model was verified.Results The rates of BMI≥28 kg/m^(2),multiple births,and T_(8) in the intra-plane≥3 minutes after anesthesia in the hypotensive group were 76.00%,64.00%,68.00%,respectively,which were significantly higher than those in the non-hypotensive group(42.67%,32.00%,28.00%),and the differences were significantly significant(P<0.05);there were no significantly significant differences in age,fetal position,gestational age,fetal weight,infusion volume before anesthesia,parity,and nursing intervention methods between the two groups(P>0.05).BMI≥28 kg/m^(2)(OR=5.049,95%CI:1.806-14.114),multiple births(OR=9.738,95%CI:3.577-26.510),and intraplane≥T_(8)(OR=7.966,95%CI:2.918-21.741)were risk factors for hypotension after cesarean section CSEA(P<0.05).The calibration curve of the nomogram prediction model for predicting hypotension after cesarean section CSEA was basically the same as the actual value,and the area under the ROC curve was 0.884(95%CI:0.820-0.948),which had a good degree of discrimination.Conclusion BMI≥28 kg/m^(2),multiple births,and 3 min intra-anesthesia≥T_(8) were risk factors for hypotension after CSEA.
作者
徐琳
何丹
郭梅
朱晓兰
XU Lin;HE Dan;GUO Mei(Department of Obstetrics,Guangyuan Central Hospital,Guangyuan Sichuan 628017,China)
出处
《临床和实验医学杂志》
2026年第3期334-336,F0003,共4页
Journal of Clinical and Experimental Medicine
基金
四川省医学会科研课题立项项目(编号:S21057)。
关键词
剖宫产
腰硬联合麻醉
低血压
列线图预测模型
Cesarean
Combined spinal and epidural anesthesia
Hypotension
Nomogram prediction model
