实用临床医药杂志2024，Vol.28Issue(20)：66-71,6.DOI:10.7619/jcmp.20242893
腰硬联合麻醉下凶险性前置胎盘剖宫产术低血压发生的诱导因素及列线图预测模型的构建
Induction factors of hypotension during cesarean section for perilous placenta previa under combined spinal-epidural anesthesia and construction of a nomogram prediction model
摘要
Abstract
Objective To investigate the induction factors of hypotension during cesarean sec-tion for perilous placenta previa under combined spinal-epidural anesthesia(CSEA)and to construct a nomogram prediction model.Methods A total of 130 parturients who underwent cesarean section for perilous placenta previa under CSEA from January 2020 to December 2023 in Yulin Maternity and Child Healthcare Hospital were selected as study subjects.A self-designed general information ques-tionnaire was used to investigate the basic information and the occurrence of hypotension of the sub-jects.According to the occurrence of intraoperative hypotension,the patients were divided into hypo-tension group(47 cases)and non-hypotension group(83 cases).Univariate analysis was performed on the general information of the two groups,and multivariate Logistic regression analysis was used to explore the induction factors of intraoperative hypotension.Results Univariate analysis showed that there were statistically significant differences in body mass index,anesthesia level,presence of multiple pregnancy,preoperative systolic blood pressure,operative time,and the occurrence of Bezold-Ja-risch reflex between the two groups(P＜0.05).Multivariate Logistic regression analysis revealed that body mass index ≥ 24 kg/m2,anesthesia level was in the eighth thoracic vertebra(T8)or a-bove,multiple pregnancy,preoperative systolic blood pressure＜90 mmHg,operative time＞1.5 h,and the occurrence of Bezold-Jarisch reflex were independent risk factors for hypotension during ce-sarean section for perilous placenta previa under CSEA(P＜0.05).A regression equation for the induction factors of hypotension during cesarean section for perilous placenta previa under CSEA was constructed:Logit(P)=-23.211+1.079 ×(body mass index≥24 kg/m2)+1.101 × anesthesia level(≥T8)+3.193 x multiple pregnancy+2.214 x preoperative systolic blood pressure(＜90 mmHg)+4.606 × operative time(＞1.5 h)+2.011 × occurrence of Bezold-Jarisch reflex.The nomogram showed high discrimination and accuracy for patients with preoperative systolic blood pres-sure＜90 mmHg.After 1,000 times of Bootstrap resampling for the nomogram model,a calibration curve was obtained,and the consistency index was calculated as 0.850,indicating good calibration of the nomogram model.The receiver operating characteristic(ROC)curve was plotted,with an ar-ea under the curve of 0.896 and 95％confidence interval of 0.802 to 0.956,suggesting good pre-dictive performance.Conclusion Body mass index ≥24 kg/m2,anesthesia level ≥ T8,multiple pregnancy,preoperative systolic blood pressure＜90 mmHg,operative time＞1.5 h,and the oc-currence of Bezold-Jarisch reflex are induction factors for hypotension during cesarean section for perilous placenta previa under CSEA.关键词
凶险性前置胎盘/剖宫产/腰硬联合麻醉/低血压/诱导因素/预测价值Key words
perilous placenta previa/cesarean section/combined spinal-epidural anesthe-sia/hypotension/induction factors/predictive value分类
医药卫生引用本文复制引用
刘伟武,曾伟兰,徐秀英,周树强,梁妙,刘丽梅,陈恒..腰硬联合麻醉下凶险性前置胎盘剖宫产术低血压发生的诱导因素及列线图预测模型的构建[J].实用临床医药杂志,2024,28(20):66-71,6.基金项目
广西壮族自治区卫生健康委员会自筹经费科研课题(Z-K20221825) （Z-K20221825）
