老年非全身麻醉腹部手术病人术后认知功能障碍预测模型的构建与验证  

Construction and validation of a predictive model for postoperative cognitive dysfunction in elderly patients undergoing abdominal surgery under non⁃general anesthesia

作　　者：刘冬梅[1] 吴显川 蒲国士 肖霞[1] 刘俊俐 谢龙昇 张永娟[1] LIU Dongmei;WU Xianchuan;PU Guoshi;XIAO Xia;LIU Junli;XIE Longsheng;ZHANG Yongjuan(Dazhou Integrated TCM&Western Medicine Hospital,Sichuan 635000 China)

机构地区：[1]达州市中西医结合医院,四川635000 [2]西南医科大学附属医院

出　　处：《护理研究》2021年第21期3780-3784,共5页Chinese Nursing Research

基　　金：西南医科大学自然科学青年基金项目,编号:2017⁃ZRQN⁃132。

摘　　要：目的:探讨老年非全身麻醉腹部手术病人发生术后认知功能障碍(POCD)相关因素,建立列线图模型并验证。方法:回顾性分析2018年7月—2020年7月行非全身麻醉腹部手术的243例老年病人的临床资料,根据术后7 d内有无POCD发生分为POCD组和对照组,采用单因素分析及Cox回归分析POCD发生的相关因素,并建立影响因素列线图预测模型并验证。结果:POCD组和对照组因资料不全分别排除2例、3例,最终两组分别纳入79例、159例;两组手术时间、术后ICU滞留时间、高血压、糖尿病、教育程度、美国麻醉医师协会(ASA)分级比较差异有统计学意义(P<0.05);Cox回归分析显示,教育程度、手术时间、术后重症监护室(ICU)滞留时间、高血压为POCD的危险因素,ASA分级Ⅰ级和Ⅱ级为保护因素;列线图预测POCD的一致性指数为0.933[95%CI(0.888,0.941)]。结论:在老年非全身麻醉腹部手术病人中,教育程度、手术时间、高血压等因素与POCD发生相关,以上述因素构建的列线图可有效预测POCD发生率。Objective:To explore the related factors of postoperative cognition dysfunction(POCD)in elderly patients with abdominal surgery under non-general anesthesia,and to construct and test the histogram model.Methods:The clinical data of 243 elderly patients who underwent abdominal surgery under non⁃general anesthesia from July 2018 to July 2020 were retrospectively analyzed.According to the occurrence of POCD within seven days after surgery,the patients were divided into POCD group and control group.Univariate analysis and Cox regression were used to analyze the related factors of POCD,and the prediction model of influencing factors was established and verified.Results:Due to incomplete data,there were two and three cases were excluded in POCD group and control group,respectively.Finally,79 cases were included in POCD group and 159 cases in control group.There were significant differences between the two groups in operative time,postoperative ICU retention time,hypertension cases,diabetes cases,education level and ASA grading(P<0.05).Cox regression analysis showed that education level,operation time,postoperative ICU stay time and hypertension were the risk factors for POCD,and ASA gradingⅠandⅡwere the protective factors.The consistency index of POCD predicted by the histogram was 0.933[95%CI(0.888,0.941)].Conclusions:In elderly patients undergoing abdominal surgery under non-general anesthesia,education level,operation time,hypertension and other factors were related to the occurrence of POCD.The constructed histogram based on the above factors could effectively predict the incidence of POCD.

关 键 词：腹部手术 认知功能 影响因素 预测 老年人 

分 类 号：R614.2[医药卫生—麻醉学]