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| 剖宫产产妇脊髓麻醉后发生低血压的列线图预测模型 |
| Nomogram prediction model for hypotension after spinal anesthesia in parturients undergoing cesarean section |
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| DOI：10.12089/jca.2026.04.009 |
| 中文关键词: 剖宫产 脊髓麻醉 低血压 影响因素 列线图模型 |
| 英文关键词: Cesarean section Spinal anesthesia Hypotension Influencing factors Nomogram model |
| 基金项目: |
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| 摘要点击次数: 683 |
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| 中文摘要: |
目的： 探讨剖宫产产妇脊髓麻醉（腰麻）后发生低血压的影响因素并构建列线图预测模型。
方法： 回顾性收集2022年5月至2024年6月行腰麻的剖宫产产妇的临床资料，根据3∶1的比例将产妇分为训练集和验证集，根据产妇腰麻后是否发生低血压将训练集分为两组：腰麻后低血压组和腰麻后无低血压组。多因素Logistic回归分析筛选剖宫产产妇腰麻后发生低血压的影响因素，并构建剖宫产产妇腰麻后发生低血压的列线图预测模型。采用Hosmer-Lemshow检验模型拟合度，受试者工作特征（ROC）曲线检验模型区分度，校准曲线检验模型校准度，决策曲线(DCA)曲线评估模型临床应用价值。
结果： 共纳入产妇228例，有80例(35.1%)发生腰麻后低血压。多因素Logistic回归分析显示，产妇年龄增大、BMI升高、新生儿体重增大、麻醉至分娩时间延长、去甲肾上腺素用量增加为剖宫产产妇腰麻后发生低血压的独立危险因素（P＜0.05）。根据以上因素构建剖宫产产妇腰麻后发生低血压的列线图预测模型。ROC曲线下面积(AUC)和校准曲线结果显示，预测模型的区分度、校准度良好。DCA曲线结果显示，当高风险阈概率为0.02～0.95之间时，列线图模型预测剖宫产产妇腰麻后低血压发生的临床净获益较高。
结论： 产妇年龄、BMI、新生儿体重、麻醉至分娩时间、去甲肾上腺素用量是剖宫产产妇腰麻后发生低血压的影响因素，根据以上因素构建的列线图模型有较高预测价值。 |
| 英文摘要: |
Objective: To investigate the influencing factors of hypotension after spinal anesthesia in parturients undergoing cesarean section and to establish a nomogram prediction model.
Methods: A retrospective collection of clinical data was conducted on cesarean section women who underwent spinal anesthesia from May 2022 to June 2024. The parturients were divided into a training set and a validation set at a ratio of 3∶1. According to the occurrence of hypotension after spinal anesthesia, the training set was further divided into two groups: hypotension group and non-hypotension group. Multivariate Logistic regression analysis was used to screen the influencing factors of hypotension after spinal anesthesia, and a nomogram prediction model was established. The goodness-of-fit was tested by the Hosmer-Lemeshow test, the discrimination by receiver operating characteristic (ROC) curve, the calibration by calibration curve, and the clinical value by decision curve analysis (DCA).
Results: A total of 228 parturients were enrolled, among whom 80 (35.1%) developed hypotension after spinal anesthesia. Increased maternal age, elevated BMI, heavier neonatal weight, prolonged anesthesia-to-delivery interval, and increased norepinephrine dosage were independent risk factors for hypotension after spinal anesthesia in parturients undergoing cesarean section (P < 0.05). A nomogram prediction model was constructed based on the above factors. The model showed satisfactory calibration and discrimination. DCA indicated that the nomogram achieved favorable net clinical benefit when the threshold probability was between 0.02 and 0.95.
Conclusion: Maternal age, BMI, neonatal weight, anesthesia-to-delivery interval, and norepinephrine dosage are influencing factors for hypotension after spinal anesthesia in parturients undergoing cesarean section. The nomogram model established based on these factors has high predictive value. |
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