腹腔镜直肠癌根治手术患者术中发生低体温的影响因素及回归方程构建

Risk factors for intraoperative hypothermia and construction of a predictive Logistic regression model in patients undergoing laparoscopic radical rectal resection

摘要:

目的 探讨腹腔镜直肠癌根治手术患者术中发生低体温的影响因素。方法 回顾性分析2023年1月－2024年12月于该院接受腹腔镜直肠癌根治手术的174例患者的临床资料，将术中发生低体温的患者纳入A组（n = 63），其余患者纳入B组（n = 111）。比较两组患者的临床资料，采用多因素Logistic回归模型，分析腹腔镜直肠癌根治手术患者术中发生低体温的独立危险因素，并构建回归方程，绘制受试者工作特征曲线（ROC curve），分析该回归方程预测腹腔镜直肠癌根治手术患者术中低体温发生风险的价值。结果 年龄 ≥ 64.52岁（OR＾ = 2.408，95%CI：1.234～4.699）、手术时间 ≥ 192.77 min（OR＾ = 2.787，95%CI：1.096～7.085）、手术等待时长 ≥ 167.43 min（OR＾ = 2.479，95%CI：1.348～4.561）、术中补液量 ≥ 2 012.35 mL（OR＾ = 2.155，95%CI：1.420～3.272）、二氧化碳（CO₂）进气量 ≥ 1 172.19 L（OR＾ = 1.929，95%CI：1.271～2.928）和腹腔镜下经腹会阴联合直肠切除术（OR＾ = 1.383，95%CI：1.117～1.712）是腹腔镜直肠癌根治手术患者术中发生低体温的独立危险因素（P 0.05）。构建回归方程：Logit（P） = -7.435+年龄×0.879 +手术时间×1.025+手术等待时间×0.908 +术中补液量×0.768 + CO₂进气量×0.657 + 腹腔镜下经腹会阴联合直肠切除术×0.324（P 0.05）。当Logit（P） 0.23时，曲线下面积（AUC）及χ²值分别为0.843和11.37，95%CI为0.780～0.893，诊断敏感度和特异度分别为85.71%和77.48%。结论 年龄 ≥ 64.52岁、手术时间 ≥ 192.77 min、手术等待时长 ≥ 167.43 min、术中补液量 ≥ 2 012.35 mL、CO₂进气量 ≥ 1 172.19 L和腹腔镜下经腹会阴联合直肠切除术，是腹腔镜直肠癌根治手术患者术中发生低体温的独立危险因素，据此构建的回归方程的预测价值较高，临床可据此尽早识别高危人群，并给予预防性措施，以减少术中低体温的发生。

Abstract:

Objective To explore the influencing factors of intraoperative hypothermia in laparoscopic radical resection of rectal cancer.Methods A retrospective analysis was conducted on the clinical data of 174 patients who underwent laparoscopic radical resection of rectal cancer from January 2023 to December 2024. Patients with hypothermia during the operation were included in group A (n = 63), and the remaining patients were included in group B (n = 111). The clinical data of the two groups of patients were compared. A multivariate logistic regression model was used to analyze the independent risk factors for hypothermia during laparoscopic radical resection of rectal cancer, and a regression equation was constructed. The receiver operating characteristic curve (ROC curve) was drawn to analyze the predictive value of hypothermia during laparoscopic radical resection of rectal cancer.Results age ≥ 64.52 years (OR＾ = 2.408, 95%CI: 1.234~4.699), operation time ≥ 192.77 min (OR＾ = 2.787, 95%CI: 1.096 ~ 7.085), waiting time for surgery ≥ 167.43 min (OR＾ = 2.479, 95%CI: 1.348 ~ 4.561), intraoperative fluid infusion volume ≥ 2 012.35 mL (OR＾ = 2.155, 95%CI: 1.420 ~ 3.272), carbon dioxide (CO₂) intake volume ≥ 1 172.19 L (OR＾ = 1.929, 95%CI: 1.271 ~ 2.928), and laparoscopic transperineal combined rectal resection (OR＾ = 1.383, 95%CI: 1.117 ~ 1.712) were independent risk factors for hypothermia during laparoscopic radical resection of rectal cancer (P 0.05). Construct the regression equation: Logit (P) = -7.435 + age × 0.879 + operation time × 1.025 + operation waiting time × 0.908 + intraoperative fluid infusion volume ×0.768 + CO₂ intake volume × 0.657 + laparoscopic transperineal combined rectal resection × 0.324 (P 0.05). When Logit (P) 0.23, the area under the curve (AUC) and the χ² value were 0.843 and 11.37 respectively, and the 95%CI was 0.780 ~ 0.893. and the diagnostic sensitivity and specificity were 85.71% and 77.48% respectively.Conclusion Age ≥ 64.52 years, operation time ≥ 192.77 min, waiting time for operation ≥ 167.43 min, intraoperative fluid infusion volume ≥ 2 012.35 mL, CO₂ intake volume ≥ 1 172.19 L and laparoscopic transperineal combined rectal resection are independent risk factors for hypothermia during laparoscopic radical resection of rectal cancer. The regression equation constructed based on this has a relatively high predictive value. Clinically, high-risk populations can be identified as early as possible based on this and preventive measures can be given to. To reduce the occurrence of intraoperative hypothermia.