摘要
目的:探讨全膝关节置换术(Total Knee Arthroplasty,TKA)患者术后寒战发生的危险因素,构建TKA术后寒战发生的Nomogram预测模型,并分析TKA患者术后寒战风险分层管理策略。方法:回顾性分析2023年1月至2025年3月期间于海安市人民医院行TKA的168例患者临床资料,根据是否发生术后寒战分为寒战发生组(37例)和寒战未发生组(131例)。比较两组临床资料,采用多因素Logistic回归分析TKA患者术后寒战的影响因素,并构建和验证TKA后寒战的Nomogram预测模型。结果:168例行TKA的患者中,术后发生寒战37例,术后寒战总发生率为22.02%。两组在年龄、术中补液总量、麻醉持续时间、术前核心体温、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、麻醉方式、手术时间、术中出血量、术后镇痛泵使用情况等方面比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄≥65岁、ASA分级Ⅲ~Ⅳ级、麻醉持续时间≥150分钟、手术时间≥90分钟、术中补液总量≥1500 m L、术中出血量≥150 m L是TKA患者术后寒战发生的独立危险因素(P<0.05)。基于多因素分析结果构建的TKA患者术后寒战Nomogram预测模型的校准曲线显示,预测概率与实际发生率拟合良好(平均绝对误差=0.031)。预测模型预测TKA患者术后寒战的受试者工作特征(Receiver Operating Characteristic,ROC)曲线的曲线下面积(Area Under Curve,AUC)为0.905(95%CI:0.843-0.967),约登指数最大时为0.774,敏感度为0.919,特异度为0.855。结论:TKA术后寒战的发生率较高,术后寒战发生的危险因素包括高龄、高ASA分级、麻醉持续时间长、手术时间长、术中补液总量大及术中出血量大。基于危险因素构建的Nomogram预测模型对TKA后寒战具有较高的预测效能,可直观、量化地评估个体TKA后寒战风险,为实施以风险分层为基础的围术期目标性体温管理提供了实用工具。
Objective:To explore the risk factors for postoperative shivering in patients undergoing total knee arthroplasty(TKA),construct a Nomogram prediction model for postoperative shivering after TKA,and analyze the risk stratification management strategy for postoperative shivering in TKA patients.Method:A retrospective analysis was conducted on the clinical data of 168 patients who underwent TKA in Hai'an People's Hospital from January 2023 to March 2025,the patients were divided into shivering group(37 cases)and non shivering group(131 cases)according to whether postoperative shivering occurred.The clinical data of the two groups were compared,the influencing factors of postoperative shivering in TKA patients were analyzed by multiple logistic regression analysis,and a Nomogram prediction model for postoperative shivering in TKA patients was constructed and validated.Results:Among the 168 patients who underwent TKA,37 experienced postoperative shivering,with a total incidence rate of 22.02%.There was a statistically significant difference between the two groups in terms of age,total intraoperative fluid replacement,anesthesia duration,preoperative core body temperature,american society of anesthesiologists(ASA)grading,anesthesia method,surgical duration,intraoperative bleeding and postoperative analgesic pump usage.Multivariate logistic regression analysis showed that,age≥65 years,ASA grade III-IV,anesthesia duration≥150 minutes,surgical duration≥90 minutes,total intraoperative fluid replacement≥1500 mL and intraoperative bleeding≥150 mL were independent risk factors for postoperative shivering in TKA patients(P<0.05).The calibration curve of the Nomogram prediction model for postoperative shivering in TKA patients based on multiple factor analysis results showed that the predicted probability fits well with the actual incidence rate(average absolute error=0.031).The area under curve(AUC)of the receiver operating characteristic(ROC)curve predicted by the predictive model for postoperative shivering in TKA patients was 0.905(95%CI:0.843-0.967),with a maximum Youden index of 0.774,sensitivity of 0.919,and specificity of 0.855.Conclusion:The incidence of postoperative shivering after TKA is relatively high,and the risk factors for postoperative shivering include advanced age,high ASA grade,long anesthesia duration,long surgical duration,large intraoperative fluid replacement and large intraoperative bleeding.The Nomogram prediction model based on risk factors has high predictive performance for post TKA shivering,which can intuitively and quantitatively evaluate individual post TKA shivering risk,providing a practical tool for implementing perioperative targeted temperature management based on risk stratification.
作者
储开云
刘艳
蒋栋
陶小红
周爱梅
刘秀敏
CHU Kai-yun;LIU Yan;JIANG Dong;TAO Xiao-hong;ZHOU Ai-mei;LIU Xiu-min(Operating Room,Hai'an People's Hospital,Nantong,Jiangsu,226600,China;Department of Orthopedics,Hai'an People's Hospital,Nantong,Jiangsu,226600,China)
出处
《现代生物医学进展》
2026年第5期728-735,共8页
Progress in Modern Biomedicine
基金
江苏省卫生健康委科研项目(Z2021090)。
