摘要
目的探讨高龄骨科手术患者发生术后谵妄(POD)的独立危险因素,并构建逐步回归风险预测模型,以期为临床治疗提供参考。方法选择2022年1月—2024年1月秦皇岛市第一医院收治的高龄骨科手术后发生谵妄的患者55例为谵妄组,选择同期收治的高龄骨科手术后未发生谵妄的患者55例为非谵妄组。通过医院电子病历系统提取患者临床资料,包括基本人口学信息、合并基础疾病、美国麻醉医师协会(ASA)分级、术前认知功能障碍情况、术前营养不良情况、生活习惯(吸烟、饮酒)、手术相关信息、实验室检查结果。采用多因素逐步回归分析影响高龄骨科手术患者发生POD的独立危险因素,并构建逐步回归风险预测模型,同时采用受试者工作特征曲线(ROC)评估所构建模型的预测效能。结果多因素逐步回归分析结果显示,ASA分级Ⅲ级(OR=17.581,95%CI:5.258~58.790)、术前认知功能障碍(OR=15.743,95%CI:1.266~195.716)、术中低氧血症(OR=16.040,95%CI:1.552~165.821)、术前白蛋白<35 g/L(OR=4.325,95%CI:1.527~12.250)是高龄骨科手术患者发生POD的独立危险因素(P<0.05)。通过Hosmer-Lemeshow检验拟合度显示,所构建风险预测模型的校准度较好(χ^(2)=0.402,P=0.999)。ROC曲线结果显示,所构建的预测模型预测高龄骨科手术患者发生POD的曲线下面积(AUC)为0.863(95%CI:0.794~0.932),敏感度为81.80%,特异度为78.20%。结论ASA分级Ⅲ级、术前认知功能障碍、术中低氧血症、术前低白蛋白水平是高龄骨科手术患者发生POD的独立危险因素,据此所构建的预测模型对于POD的发生具有较好的预测效能。
Objective To explore the independent risk factors for postoperative delirium(POD)in elderly orthopedic surgery patients and to construct a stepwise regression-based risk prediction model,in order to provide support for clinical treatment.Methods A total of 55 elderly orthopedic surgery patients with POD were selected as the delirium group(POD group),and 55 elderly orthopedic surgery patients without POD were selected as the non-delirium group.All patients were admitted to the First Hospital of Qinhuangdao from January 2022 to January 2024.Clinical data,including demographic information,comorbidities,American Society of Anesthesiologists(ASA)classification,preoperative cognitive dysfunction,preoperative malnutrition,lifestyle habits(smoking,drinking),surgical information,and laboratory results,were extracted from the hospital's electronic medical record system.Multivariate stepwise regression analysis was used to identify the independent risk factors for POD in elderly orthopedic surgery patients and to construct a risk prediction model.The model's predictive performance was evaluated using receiver operating characteristic(ROC)curves.Results The multivariate stepwise regression analysis revealed that ASA classificationⅢ(OR=17.581,95%CI:5.258-58.790),preoperative cognitive dysfunction(OR=15.743,95%CI:1.266-195.716),intraoperative hypoxemia(OR=16.040,95%CI:1.552-165.821),and preoperative albumin level<35 g/L(OR=4.325,95%CI:1.527-12.250)were independent risk factors for POD in elderly orthopedic surgery patients(P<0.05).The Hosmer-Lemeshow test showed good calibration for the constructed risk prediction model(χ^(2)=0.402,P=0.999).The ROC curve results indicated that the area under the curve(AUC)for predicting POD in elderly orthopedic surgery patients was 0.863(95%CI:0.794-0.932),with a sensitivity of 81.80%and a specificity of 78.20%.Conclusion ASA classificationⅢ,preoperative cognitive dysfunction,intraoperative hypoxemia,and low preoperative albumin levels are independent risk factors for the occurrence of POD in elderly orthopedic surgery patients.The prediction model constructed based on these factors demonstrates good predictive efficacy for POD occurrence.
作者
唐莲莲
赵立坤
田英慧
李佳
岳淑玲
李铁松
陈晓敏
Tang Lianlian;Zhao Likun;Tian Yinghui;Li Jia;Yue Shuling;Li Tiesong;Chen Xiaomin(Department of Nursing,The First Hospital of Qinhuangdao,Qinhuangdao Hebei 066000,China;Department of Orthopedics,The First Hospital of Qinhuangdao,Qinhuangdao Hebei 066000,China;Coronary Care Unit,The First Hospital of Qinhuangdao,Qinhuangdao Hebei 066000,China;Department of Cardiology,North China University of Science and Technology Affiliated Hospital,Tangshan Hebei 063000,China)
出处
《保健医学研究与实践》
2024年第9期44-49,55,共7页
Health Medicine Research and Practice
基金
河北省医学科学研究课题计划项目(20221612)
河北省秦皇岛市科学技术研究与发展计划项目(2017C045)。
关键词
骨科手术
高龄
术后谵妄
风险模型
Orthopedic surgery
Elderly
Postoperative delirium
Risk model
