基于倾向性评分匹配法分析术前血钙水平与老年心外科手术患者术后谵妄的关系  

The relationship between preoperative blood calcium level and postoperative delirium in elderly patients undergoing cardiac surgery based on propensity score matching method

作　　者：吴建强[1] 王征 邹正丽 文智 伍长学 WU Jian-qiang;WANG Zheng;ZOU Zheng-li;WEN Zhi;WU Chang-xue(Department of Cardiac Surgery,Deyang People’s Hospital,Deyang 618000,China)

机构地区：[1]德阳市人民医院心外科,四川省德阳市618000

出　　处：《中国心血管病研究》2024年第4期341-345,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的基于倾向性评分匹配法(PSM)分析术前血钙水平与老年心外科手术患者术后谵妄的关系。方法回顾性分析2020年5月至2023年10月德阳市人民医院心外科接受手术治疗的166例老年患者临床资料,依据术后住院期间是否发生谵妄将其分为发生组(52例)、未发生组(114例),采用PSM对两组患者临床资料进行匹配后得到组间协变量均衡的样本,单因素、logistic多因素回归分析法明确影响老年心外科手术患者术后谵妄的危险因素,受试者工作特征曲线(ROC)评估术前血钙水平预测老年心外科手术患者术后谵妄的效能。结果PSM后,共得到47对组间协变量均衡的样本。发生组、未发生组合并糖尿病比例、术后输注红细胞比例及白蛋白、血肌酐、血钙、神经元特异性烯醇酶(NSE)水平差异有统计学意义(P<0.05),合并高血压、高血脂比例、手术类型、血红蛋白、血小板计数等指标水平无明显差异(P>0.05)。Logistic多因素回归分析,结果显示,合并糖尿病(OR=1.790,95%CI 1.627~1.952)、白蛋白水平低(OR=1.804,95%CI 1.516~2.092)、血肌酐水平高(OR=1.844,95%CI 1.563~2.125)、血钙水平高(OR=1.835,95%CI 1.612~2.058)、NSE水平高(OR=1.840,95%CI 1.524~2.157)、术后输注红细胞(OR=1.808,95%CI 1.458~2.254)是影响老年心外科手术患者术后谵妄的危险因素,即上述指标与老年心外科手术患者术后谵妄有关。ROC曲线结果显示,术前血钙水平预测老年心外科手术患者术后谵妄的敏感度、特异度、AUC分别为87.50%、77.30%、0.906。结论老年心外科手术患者术后谵妄发生风险较高,术前血钙水平与老年心外科手术患者术后谵妄密切相关,且术前血钙水平升高可能是老年心外科手术患者术后谵妄发生的有效预测因子。Objective To explore the relationship between preoperative blood calcium level and postoperative delirium in elderly patients undergoing cardiac surgery based on propensity score matching method(PSM).Methods The data of 166 elderly patients who received surgical treatment in the Department of Cardiac Surgery of the hospital from May 2020 to October 2023 were retrospectively analyzed;according to whether delirium occurred during the postoperative hospitalization,they were divided into the developing group(52 cases)and non-developing group(114 cases).PSM was used to match the clinical data of the two groups to obtain samples with balanced covariates between the 2 groups;univariate and logistic multivariate regression analysis were used to identify the risk factors for postoperative delirium,and receiver operating characteristic curve(ROC)was used to evaluate the efficacy of preoperative blood calcium level in predicting postoperative delirium.Results After PSM,a total of 47 pairs of covariate balanced samples were obtained.There were significant differences in the proportion of diabetes mellitus and red blood cells transfused after operation,and the levels of albumin,serum creatinine,serum calcium and neuro-specific enolase(NSE)between the developing group and the non-developing group(P<0.05);there were no significant differences in the proportion of hypertension and hyperlipidemia,type of operation,hemoglobin and platelet count(P>0.05).Logistic multivariate regression analysis showed that diabetes mellitus(OR=1.790,95%CI 1.627~1.952),low albumin level(OR=1.804,95%CI 1.516~2.092),high serum creatinine level(OR=1.844,95%CI 1.563~2.125),high blood calcium level(OR=1.835,95%CI 1.612~2.058),high NSE level(OR=1.840,95%CI 1.524~2.157),postoperative red blood cell transfusion(OR=1.808,95%CI 1.458~2.254)were the risk factors of postoperative delirium.ROC curve results showed that the sensitivity,specificity and AUC of preoperative blood calcium level in predicting postoperative delirium were 87.50%,77.30%and 0.906 respecti

关 键 词：心外科手术 术后谵妄 老年 血钙 倾向性评分匹配法 

分 类 号：R654.2[医药卫生—外科学]