老年上腹部手术患者术后谵妄风险预测模型的构建及验证  

Development and Verification of a Risk Prediction Model for Postoperative Delirium in Elderly Patients Undergoing Upper Abdominal Surgery

作　　者：陈璐[1] 谢新芳[2] 孔骞 谢平[1] 单汉民[1] 沈小英[1] 丁秋平[1] CHEN Lu;XIE Xinfang;KONG Qian;XIE Ping;SHAN Hanmin;SHEN Xiaoying;DING Qiuping(General Surgery Department,Huzhou Central Hospital,Huzhou 313000,Zhejiang Province,China;Nursing Department,Huzhou Central Hospital;Intensive Care Unit,Shijiazhuang People’s Hospital,Shijiazhuang 050000,Hebei Province,China)

机构地区：[1]湖州市中心医院普外科,浙江湖州313000 [2]湖州市中心医院护理部 [3]石家庄市人民医院重症医学科,河北石家庄050000

出　　处：《解放军护理杂志》2022年第6期5-8,共4页Nursing Journal of Chinese People's Liberation Army

基　　金：浙江省医药卫生科技计划项目(2020KY305)。

摘　　要：目的 构建老年上腹部手术患者术后谵妄(postoperative delirium,POD)风险预测模型,并验证其预测效果,以期为早期识别POD发生风险提供依据。方法 2019年9月至2020年6月,选取某三级甲等医院接受上腹部手术的252例老年患者病例资料,比较谵妄组和非谵妄组的各项指标,探索独立危险因素,建立预测模型。用受试者工作特征曲线(receiver operating characteristic curve,ROC)检验模型的预测效果。选取126例同类患者进行模型预测效果验证。结果 谵妄组和非谵妄组患者在年龄、APACHEⅡ评分、高血压、心脏疾病、脑血管意外、手术时限分类、手术等级、睡眠紊乱、术后高热≥38.5℃、术后环境、术后机械通气、术后镇痛药、身体被动约束等方面的差异均有统计学意义(均P<0.05)。年龄、心脏疾病、手术时限分类、睡眠紊乱、术后环境是老年患者上腹部手术后谵妄的独立危险因素。ROC曲线下面积0.665,约登指数0.309,灵敏度0.388,特异度0.921。模型验证准确率为90.5%。结论 构建的预测模型能较好地预测老年患者上腹部手术后谵妄的发生风险,值得在临床推广。Objective To construct and evaluate the effect of a risk prediction model for postoperative delirium(POD)in elderly patients undergoing upper abdominal surgery,and to provide a basis for early identification of the POD occurrence.Methods A total of 252 elderly patients underwent upper abdominal surgery in a tertiary A hospital from September 2019 to June 2020 were selected,and indicators of the delirium group and the non-delirium group were compared.Independent risk factors were explored for the establishment of the predictive model.The receiver operating characteristic curve(ROC)was used to test the prediction effects of the model.126 patients of the same type were selected to evaluate the model’s effects.Results There were statistically significant differences between delirium group and non-delirium group in age,APACHEⅡscore,hypertension,heart disease,cerebrovascular accident,operation duration classification,operation grade,sleep disorder,postoperative high fever≥38.5℃,postoperative environment,postoperative mechanical ventilation,postoperative analgesics,body passive restraint,etc.(all P<0.05).Age,heart disease,duration classification,sleep disturbance and postoperative environment were independent risk factors for delirium after upper abdominal surgery in elderly patients.The area under ROC curve was 0.665,with youden index 0.309,sensitivity 0.388 and specificity 0.921.The model validation accuracy was 90.5%.Conclusions The predictive model can better predict the risk of delirium in elderly patients after upper abdominal surgery,and it is worth promoting in clinic.

关 键 词：老年患者 上腹部手术 术后谵妄 风险预测模型 

分 类 号：R473.6[医药卫生—护理学]