非体外循环冠脉搭桥术后认知障碍的风险个体化预测研究  

Risk individualized prediction of cognitive impairment after off-pump coronary artery bypass grafting

作　　者：高源 王俊生[1] 杨书强[1] GAO Yuan;WANG Junsheng;YANG Shuqiang(Department of Cardiac Vascular Surgery,Anyang City People's Hospital,Anyang,Henan 455001,China)

机构地区：[1]安阳市人民医院心脏大血管外科,河南安阳455001

出　　处：《中国医学工程》2023年第11期25-32,共8页China Medical Engineering

摘　　要：目的探讨非体外循环冠脉搭桥术后认知障碍的影响因素,并据此构建预测列线图模型。方法回顾性分析安阳市人民医院2020年2月至2022年12月收治的192例行非体外循环冠脉搭桥术患者的临床资料,按照2∶1的比例将其分为建模组(128例)和验证组(64例)。使用蒙特利尔认知评估量表(MoCA)分别在术前和术后7 d对患者认知功能进行评估,根据术后是否发生认知功能障碍将建模组患者分为障碍组和无障碍组。对比障碍组和无障碍组的临床资料,采用多因素Logistic回归性分析法分析非体外循环冠脉搭桥术后患者发生认知障碍的影响因素,并构建预测列线图模型。采用Bootstrap法进行内部验证,绘制校准曲线;采用受试者工作特征(ROC)曲线以评估列线图模型的预测效能;采用决策曲线(DCA)验证模型的临床净获益率。结果192例非体外循环冠脉搭桥术患者发生认知功能障碍的有66例,发生率为34.38%,其中建模组128例患者有45例发生认知功能障碍,发生率为35.16%;验证组64例患者有21例发生认知功能障碍,发生率为32.81%。障碍组中年龄≥65岁、初中及以下文化程度、吸烟史、糖尿病、高血压、颈动脉狭窄、主动脉斑块、手术麻醉时间>4h、术中血红蛋白浓度下降率(ΔHb)≥40%、术后全身炎症反应综合征(SIRS)评分>2分占比均高于无障碍组(P<0.05);经多因素Logistic回归性分析,年龄≥65岁、初中及以下文化程度、吸烟史、高血压、颈动脉狭窄、主动脉斑块、糖尿病、ΔHb≥40%、手术麻醉时间>4h、SIRS评分>2分均是非体外循环冠脉搭桥术后患者发生认知功能障碍的危险因素(P<0.05);将上述影响因素作为预测指标,构建非体外循环冠脉搭桥术后患者发生认知功能障碍的风险预测列线图模型,建模组和验证组列线图模型预测校准曲线的一致性指数分别为0.807、0.786,二者校准曲线均接近标准曲线;ROC曲线分析结�【Objective】To investigate the influencing factors of cognitive impairment after off-pump coronary artery bypass grafting and construct a predictive graph model.【Methods】The clinical data of 192 patients undergoing off-pump coronary artery bypass grafting admitted to our hospital from February 2020 to December 2022 were retrospectively analyzed,and they were divided into modeling group(128 cases)and verification group(64 cases)according to a ratio of 2:1.The Montreal Cognitive Assessment(MoCA)Scale was used to assess the cognitive function of the patients before and 7 days after surgery.The patients in the modeling group were divided into the obstacle group and non-obstacle group according to the occurrence of postoperative cognitive dysfunction.The clinical data of the obstacle group and non-obstacle group were compared.Multivariate Logistic regression analysis was used to analyze the influencing factors of cognitive impairment after off-pump coronary artery bypass grafting,and a predictive graph model was built.Bootstrap method was used for internal verification and calibration curve was drawn.Receiver operating characteristic(ROC)curve was used to evaluate the predictive efficiency of the line graph model.Decision curve analysis(DCA)was used to verify the clinical net benefit rate of the model.【Results】Among the 192 patients undergoing off-pump coronary artery bypass grafting,66 cases had cognitive dysfunction,and the incidence was 34.38%.Among the 128 patients in the modeling group,45 had cognitive dysfunction,and the incidence was 35.16%.Among the 64 patients in the verification group,21 had cognitive dysfunction,and the incidence was 32.81%.The proportions of age≥65 years old,education level of junior high school or below,smoking history,diabetes mellitus,hypertension,carotid artery stenosis,aortic plaque,duration of anesthesia>4 hours,intraoperative hemoglobin concentration decrease rate(ΔHb)≥40%,postoperative systemic inflammatory response syndrome(SIRS)score>2 points in the obstacle group

关 键 词：非体外循环 冠脉搭桥术 认知功能障碍 危险因素 

分 类 号：R654.2[医药卫生—外科学]