椎管内分娩镇痛产妇产时发热预测模型的建立与验证

Establishment and validation of predictive model for spinal canal labor analgesia-related intrapartum fever

中文关键词: 椎管内分娩镇痛  产时发热  预测模型  危险因素

英文关键词: Spinal canal labor analgesia  Intrapartum fever  Predictive model  Risk factors

中文摘要:

      
目的：建立椎管内分娩镇痛产妇产时发热预测模型并验证其效能。
方法：选择2021年1—12月行椎管内分娩镇痛产妇2 276例作为训练集，年龄≥18岁，BMI 18.5～40.0 kg/m²，ASA Ⅰ或Ⅱ级，根据产妇是否出现产时发热（体温≥38.0 ℃）分为两组：发热组与未发热组。采用多因素Logistic回归分析确定椎管内分娩镇痛产妇产时发热的危险因素并建立预测模型。选择2022年1—3月于同一医院行椎管内分娩镇痛产妇568例作为验证集，纳入标准与训练集相同，通过R语言进行模型的外部验证。
结果：本研究训练集中有197例（8.7%）产妇出现产时发热；验证集中有46例（8.1%）产妇出现产时发热。多因素Logistic回归分析显示，训练集中初产妇、中性粒细胞计数升高、贫血及预估新生儿体重增加是产时发热的独立危险因素，体表面积增大和分娩镇痛前宫口增大是产时发热的保护因素。根据上述危险因素建立椎管内分娩镇痛产妇产时发热的预测模型，受试者工作特征（ROC）曲线下面积（AUC）为0.698（95%CI 0.660～0.732），敏感性为83.2%，特异性为47.9%。验证集中通过R语言进行外部验证，预测模型的AUC为0.703（95%CI 0.634～0.772），敏感性为65.2%，特异性为71.3%。
结论：初产妇、中性粒细胞计数升高、贫血及预估新生儿体重增加是产时发热的危险因素，体表面积增大和分娩镇痛前宫口增大是保护性因素，基于这些指标构建的预测模型可以较好地在分娩镇痛前预测产时发热的发生。

英文摘要:

      
Objective: To establish a predictive model for spinal canal labor analgesia-related intrapartum fever and validate its predictive efficacy.
Methods: A total of 2 276 parturients who received labor analgesia from January to December 2021 were selected as the training set, aged ≥ 18 years, BMI 18.5-40.0 kg/m², ASA physical status Ⅰ or Ⅱ. The patients were divided into fever group and non-fever group according to the occurrence of intrapartum fever (body temperature ≥ 38.0 ℃). The independent risk factors of intrapartum fever were screened by multivariate logistic regression, and the predictive model was established. A total of 568 parturients who received labor analgesia in the same hospital from January to March 2022 were selected as the verification. The inclusion criteria were the same as the training set, and the model was externally verified by R language.
Results: There were 197 parturients (8.7%) in the training set and 46 parturients (8.1%) in the validation set experienced intrapartum fever. The multivariate logistic regression analysis showed that primiparity, a high neutrophil count, anemia, and a heavier estimated fetal weight were risk factors of intrapartum fever, while a large body surface area and large cervical dilatation degree before labor analgesia were protective factors against intrapartum fever. According to the predictors, the predictive model for spinal canal labor analgesia-related maternal fever was established. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.698 (95% CI 0.660-0.732), the sensitivity and specificity was 83.2% and 47.9%, respectively. Using R language for the external validation, the AUC of the predictive model was 0.703 (95% CI 0.634-0.772), the sensibility and specificity was 65.2% and 71.3%, respectively. The results showed that the prediction model for spinal canal labor analgesia-related intrapartum fever is effective.
Conclusion: Primiparity, a high neutrophil count, anemia, and a heavier estimated fetal weight were risk factors of intrapartum fever, while a large body surface area and large cervical dilatation degree before labor analgesia were protective factors. The predictive model established based on these indicators can effectively predict the occurrence of intrapartum fever before labor analgesia．