结合术前营养评估结果的老年髋部骨折术后谵妄Nomogram模型构建  

Construction of Nomogram model of postoperative delirium in elderly patients with hip fracture combined with preoperative nutritional assessment results

作　　者：熊春红[1] 熊淑明[1] 王小云[1] 李欣[1] 方亮[1] XIONG Chunhong;XIONG Shuming;WANG Xiaoyun;LI Xin;Fang Liang(The Second Affiliated Hospital of Nanchang University,Jiangxi 330006 China)

机构地区：[1]南昌大学第二附属医院,江西330006

出　　处：《护理研究》2020年第14期2457-2462,共6页Chinese Nursing Research

基　　金：国家自然科学基金委员会资助项目,编号:81250022;江西省卫生计生委科技计划项目,编号:20195283;江西省卫生厅科技计划项目,编号:20133050。

摘　　要：[目的]结合术前营养评估结果构建老年髋部骨折术后谵妄Nomogram模型。[方法]选取2015年1月—2019年1月在我院就诊的325例老年髋部骨折病人作为研究对象。采用单因素和多因素Logistic回归模型分析老年髋部骨折病人术后发生谵妄的独立危险因素。根据独立危险因素构建Nomogram模型。[结果]325例病人中,营养正常病人119例(36.6%),存在营养不良风险病人144例(44.3%),营养不良病人62例(19.1%)。营养正常病人中13例病人发生谵妄,在存在营养不良风险病人中41例病人发生谵妄,营养不良病人中28例病人发生谵妄。多因素Logistic回归结果显示:年龄≥73岁(HR=1.830)、MMSE评分<23分(HR=2.016)、有痴呆史(HR=6.578)、有糖尿病史(HR=2.785)、存在营养不良风险(HR=5.278)、营养不良(HR=3.505)是术后谵妄发生的独立危险因素(P<0.05)。将多因素Logistic回归结果中的独立危险因素作为预测因子构建Nomogram模型,采用内部数据进行验证,C-index为0.858,95%CI(0.668,0.925),校准图形中标准曲线与预测校准曲线贴合良好。[结论]根据术前营养评估结果构建的老年髋部骨折术后谵妄Nomogram模型预测效果较好。Objective:To construct a Nomogram model of postoperative delirium in elderly patients with hip fracture combined with preoperative nutritional assessment.Methods:Totally 325 elderly patients with hip fracture,who received treatment in our hospital,were selected as research subjects from January 2015 to January 2019.Single factor and multivariate Logistic regression models were used to analyze independent risk factors of postoperative delirium in elderly patients with hip fracture.Nomogram model was constructed on the basis of independent risk factors.Results:Among 325 patients,there were 119 patients(36.6%)with normal nutrition.There were 144 patients(44.3%)at the risk of malnutrition.And there were 62 patients(19.1%)with malnutrition.There were 13 patients with normal nutrition,delirium in 41 patients at the risk of malnutrition,and 28 patients with malnutrition suffering from delirium.Multivariate Logistic regression showed that age≥73 years old(HR=1.830),MMSE score<23(HR=2.016),history of dementia(HR=6.578),history of diabetes(HR=2.785),malnutrition risk(HR=5.278)and malnutrition(HR=3.505)were independent risk factors for postoperative delirium(P<0.05).Taking independent risk factors in multivariate Logistic regression results regarded as predictors,Nomogram model was constructed.Verification was conducted by internal data.Results showed that C-index was 0.858,95%CI(0.668,0.925).And standard curve and predicted calibration curve fitted well in calibration graph.Conclusions:Nomogram model of postoperative delirium in elderly patients with hip fracture based on preoperative nutritional assessment,has a good predictive effect on postoperative delirium.

关 键 词：营养评估 老年人 髋部骨折 谵妄 Nomogram模型 危险因素 

分 类 号：R473.6[医药卫生—护理学]