全麻甲状腺癌根治术患者苏醒期谵妄发生的列线图预测模型的建立  

Establishment of Nomogram predictive model of delirium during postoperative recovery period of thyroid cancer patients undergoing radical thyroidectomy under general anesthesia

作　　者：王永波 卢秀波[1] 张清君[1] 林素红 陈亚丽[1] WANG Yongbo;LU Xiubo;ZHANG Qingjun;LIN Suhong;CHEN Yali(Department of Thyroid Surgery,the First Affiliated Hospital,Zhengzhou University, Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院甲状腺外科,郑州450052

出　　处：《郑州大学学报（医学版）》2020年第3期386-390,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省科技攻关计划项目(172102310033)。

摘　　要：目的:建立能够评估全麻甲状腺癌根治术患者苏醒期谵妄发生的列线图(Nomogram)预测模型。方法:选取本院甲状腺外科收治、行全麻甲状腺癌根治术的患者255例,基于苏醒期是否发生谵妄分为非谵妄组186例和谵妄组69例,自行设计临床调查病例报告表采集两组患者人口学及临床资料,以苏醒期是否发生谵妄为因变量,以logistic回归筛选出的变量为预测变量,应用R语言建立Nomogram预测模型。结果:Logistic回归分析显示,年龄(OR=1.980,95%CI=1.253~3.130)、ASA分级(OR=4.029,95%CI=2.517~6.435)、麻醉药物用量(OR=1.032,95%CI=1.003~1.062)、拔管时间(OR=1.625,95%CI=1.064~2.481)和PACU停留时间(OR=1.447,95%CI=1.072~1.952)是甲状腺癌患者苏醒期谵妄发生的影响因素(P<0.05)。Nomogram预测模型显示,各因素的风险总分为123~182,风险率为0.001~0.999;总分越高,苏醒期发生谵妄的风险越高。ROC曲线分析显示,Nomogram预测模型风险总分预测甲状腺癌患者苏醒期谵妄的曲线下面积为0.878(95%CI=0.820~0.936)(P<0.001)。结论:构建的Nomogram预测模型预测效能较好,可实现对苏醒期谵妄发生的可视化、图形化预测。Aim:To establish a Nomogram predictive model for evaluating the occurrence of delirium during recovery period in patients undergoing radical thyroidectomy under general anesthesia.Methods:A total of 255 patients who underwent radical thyroidectomy under general anesthesia were selected.Based on whether delirium occurred during recovery period,255 patients were divided into two groups(186 in non-delirium group and 69 in delirium group).The demographic and clinical data,operation and anesthesia situation and post-operation situation of the two groups were collected by self-designed clinical investigation case report form.The Nomogram predictive model was established by R language.Results:Logistic regression analysis showed that age(OR=1.980,95%CI=1.253-3.130),ASA grade(OR=4.029,95%CI=2.517-6.435),anesthetic dosage(OR=1.032,95%CI=1.003-1.062),extubation time(OR=1.625,95%CI=1.064-2.481)and PACU stay time(OR=1.447,95%CI=1.072-1.952)were the influencing factors of delirium(P<0.05).Nomogram analysis showed that the total risk score of the factors was 123-182,and the risk rate was 0.001~0.999.ROC curve analysis showed that the area under curve of Nomogram′s total risk score for predicting delirium was 0.878(95%CI=0.820-0.936,P<0.001).Conclusion:The established Nomogram prediction model is effective in predicting the occurrence of delirium in the recovery period of thyroid cancer patients undergoing radical thyroidectomy under general anesthesia,which could realize visual graphical prediction of delirium.

关 键 词：全麻 甲状腺癌 苏醒期 谵妄 列线图 

分 类 号：R736.1[医药卫生—肿瘤]