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    男性病人全麻苏醒期发生导尿管相关膀胱刺激征的危险因素与风险预测模型构建

    Investigation of the risk factors of CRBD in male patients during the recovery period of general anesthesia and construction of risk prediction model

      摘要
    • 摘要:
      目的 探讨男性病人全麻苏醒期发生导尿管相关膀胱刺激征(catheter-related bladder discomfort, CRBD)的危险因素，基于此开发出列线图风险预测模型并加以验证。
      方法 2020年12月至2024年6月行全麻手术下留置导尿管的男性病人，根据在全麻苏醒期是否发生CRBD将病人分为CRBD组与非CRBD组，比较2组病人的临床相关资料，采用多因素logistic回归分析有效影响因素，并绘制列线图模型图，检验列线图的有效价值；
      结果 2组病人临床资料在体质量指数(BMI)、合并高血压病史、手术类型、麻醉复苏时长、既往是否有导尿史、麻醉后导尿、术中是否应用右美托咪定、术中舒芬太尼的剂量等指标之间差异均有统计学意义(P < 0.05~P < 0.01)；多因素logistic回归分析显示BMI≥26.75 kg/m2、麻醉复苏时长≥39.5 min、既往有导尿史、麻醉后导尿、术中舒芬太尼剂量低于1.2 μg/kg是男性病人全麻苏醒期发生CRBD的危险因素(P < 0.05~P < 0.01)，术中应用右美托咪定是男性病人全麻苏醒期发生CRBD的保护因素(P < 0.01)；列线图模型拟合良好(χ2=5.22，P>0.05)，ROC曲线下面积为0.847(95%CI：0.813~0.881)，DCA曲线净获益均高于All线和None线。
      结论 BMI≥26.75 kg/m2、麻醉复苏时长≥39.5 min、既往有导尿史、麻醉后置入导尿管、舒芬太尼剂量低、术中应用右美托咪定与男性病人全麻苏醒期发生导尿管相关膀胱刺激征相关，基于此构建的列线图模型有较好的临床适用性。

       

      Abstract:
      Objective To investigate the risk factors of catheter-related bladder discomfort(CRBD) in male patients during the recovery period of general anesthesia, and develop and validate a nomogram risk prediction model based on these factors.
      Methods The male patients undergoing general anesthesia surgery with indwelling urinary catheters from December 2020 to June 2024 were divided into the CRBD group and non-CRBD group based on the occurrence of CRBD during during the recovery period of general anesthesia.The clinical data were compared between two groups.Multivariate logistic regression analysis was used to identify the significant influencing factors.A nomogram model was constructed, and its validity was assessed.
      Results The differences of the clinical data including BMI, history of hypertension, type of surgery, duration of anesthesia recovery, history of prior catheterization, post-anesthesia catheter insertion, intraoperative use of dexmedetomidine and intraoperative sufentanil dose were statistically significant between two groups(P < 0.05 to P < 0.01).The results of multivariate logistic regression analysis showed that the BMI ≥26.75 kg/m2, anesthesia recovery duration ≥39.5 minutes, history of prior catheterization, post-anesthesia catheter insertionand intraoperative sufentanil dose < 1.2 μg/kg were the independent risk factors of CRBD in male patients during the recovery period of general anesthesia(P < 0.05 to P < 0.01).Intraoperative use of dexmedetomidine was identified as a protective factor against CRBD(P < 0.01).The nomogram model demonstrated good fit(χ2=5.22, P>0.05).The area under the ROC curve was 0.847(95%CI: 0.813-0.881).The decision curve analysis (DCA) showed the net benefit of nomogram was consistently higher than that of "all" and "none" lines.
      Conclusions The BMI ≥26.75 kg/m2, anesthesia recovery duration ≥39.5 minutes, history of prior catheterization, post-anesthesia catheter insertion, lower sufentanil dose, and intraoperative use of dexmedetomidine are associated with the occurrence of CRBD in male patients during the recovery period of general anesthesia general anesthesia.The nomogram prediction model constructed based on these factors demonstrates good clinical applicability.

       

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