摘要
目的:分析硬膜外分娩镇痛中转剖宫产时硬膜外麻醉失效的相关因素,构建麻醉失效的预测模型并进行模型的内部验证。方法:回顾性分析2020年1月至2021年12月广州医科大学附属第三医院收治的硬膜外分娩镇痛中转剖宫产的足月初产单活胎产妇548例的临床资料,根据中转剖宫产时单纯硬膜外麻醉是否成功开始手术分为成功组(n=460)和失效组(n=88),采用单因素分析和多因素Logistic回归分析硬膜外麻醉失效的影响因素,应用R软件建立列线图模型并进行内部验证。结果:单因素分析显示,分娩镇痛麻醉医生年资、中转剖宫产指征、硬膜外分娩镇痛持续时间(T1)以及硬膜外麻醉2%甲哌卡因使用情况是硬膜外麻醉失效的影响因素(均P<0.05)。多因素Logistic回归分析显示,硬膜外分娩镇痛麻醉医生年资为主治医师或副主任医师(OR=0.443,P=0.048)、硬膜外麻醉使用2%甲哌卡因(OR=0.042,P<0.001)为硬膜外麻醉失效的保护因素;而中转剖宫产指征为母体因素或产程因素(OR=2.557,P=0.011;OR=2.118,P=0.015)、T1长(OR=1.667,P=0.061)为硬膜外麻醉失效的危险因素。建立T1预测中转剖宫产时硬膜外麻醉失效的受试者工作特征曲线(ROC),其曲线下面积(AUC)为0.577(95%CI:0.510~0.644,P=0.024),T1临界值为552.5 min(9.2 h)。利用以上相关因素建立列线图模型,模型的AUC为0.716(95%CI:0.655~0.777,P<0.001),通过验证显示模型的区分度、校准度和临床效益均良好。结论:中转剖宫产时硬膜外麻醉失效的影响因素复杂多样。本研究构建的硬膜外麻醉失效预测模型具有良好的准确度,有一定的临床价值。
Objective:To analyze the related factors for epidural analgesia failed during epidural labour analgesia conversion to cesarean section,to construct a risk prediction model for epidural analgesia failed,and to conduct internal validation of the model.Methods:The 548 puerperae who underwent epidural cesarean section after epidural labor analgesia in the Third Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed and all the fetus were full-term,singleton and live birth.According to whether the sole epidural anesthesia was started successfully during cesarean section,the puerperae were divided into successful group(n=460)and failure group(n=88).Univariate analysis and multivariate logistic regression analysis were used to analyze the influencing factors of epidural anesthesia failure,R software was used to establish a nomogram model and conduct internal verification.Results:Univariate analysis showed that the factors affecting the failure of epidural anesthesia were the seniority of the anesthesiologist for labor analgesia,the indication of cesarean section,the duration of epidural labor analgesia(T1)and the use of 2%mepivacaine for epidural anesthesia(all P<0.05).Multivariate logistic regression analysis showed that the seniority of epidural labor analgesia anesthesiologist as attending physician or associate chief physician(OR=0.443,P=0.048)and the use of 2%mepivacaine for epidural anesthesia(OR=0.042,P<0.001)were protective factors for epidural anesthesia failure;Meanwhile,the indications for cesarean section were maternal factors or labor factors(OR=2.557,P=0.011;OR=2.118,P=0.015)and the prolonged T1(OR=1.667,P=0.061)were risk factors for epidural anesthesia failure.The receiver operating characteristic(ROC)curve of T1 for predicting the failure of epidural anesthesia during cesarean section was established,and the area under curve(AUC)is 0.577(95%CI:0.510-0.644,P=0.024),and the cut-off value of T1 was 552.5 min(9.2 h).The nomogram model was developed accordingly,and the model AUC was 0.716(95%CI:0.655-0.777,P<0.001).By verification,the model showed good differentiation,calibration and clinical benefits.Conclusions:The influencing factors of epidural anesthesia failure during cesarean section are complex and diverse.The prediction model of epidural anesthesia failure constructed in this study has good accuracy and certain clinical value.
作者
邓艳娜
王寿平
DENG Yanna;WANG Shouping(Department of Anesthesiology,Huizhou Third People's Hospital,Huizhou Hospital Affiliated to Guangzhou Medical University,Huizhou 516000,Guangdong,China;Department of Anesthesiology,The Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,Guangdong,China)
出处
《广州医科大学学报》
2023年第6期11-17,共7页
Academic Journal of Guangzhou Medical University
基金
广东省科技厅基础与应用基础面上项目(2021A1515220002)
广州市科技局市校联合项目(202201020389)
惠州市科技局科技计划项目(210422114572958)
荔湾区科技计划重点卫生科研项目(202201011)。
关键词
麻醉
硬膜外
镇痛
产科
分娩疼痛
剖宫产术
预测模型
anesthesia,epidural
analgesia,obstetrical
labor pain
cesarean section
prediction model
