原发性肺癌切除术后谵妄的危险因素及预后分析  

Risk scoring system and prognosis analysis of postoperative delirium in patients with primary lung cancer

作　　者：袁延丽 屈卓军 崔会慧 王菁 高贝贝 潘院 Yuan Yanli;Qu Zhuojun;Cui Huihui;Wang Jing;Gao Beibei;Pan Yuan(Department of Respiratory and Critical Care Medicine,The Second Affiliated Hospital of the Air Force Military Medical University,Xi′an 710038,China;Department of Cerebral Surgery,The Second Affiliated Hospital of the Air Force Military Medical University,Xi′an 710038,China;Department of Respiratory Medicine,The Second Affiliated Hospital of the Air Force Military Medical University,Xi′an 710038,China)

机构地区：[1]空军军医大学第二附属医院呼吸与危重症医学科,西安710038 [2]空军军医大学第二附属医院胸外科,西安710038 [3]空军军医大学第二附属医院呼吸内科,西安710038

出　　处：《中华肺部疾病杂志（电子版）》2024年第5期701-706,共6页Chinese Journal of Lung Diseases(Electronic Edition)

摘　　要：目的分析原发性肺癌切除术后谵妄(postoperative delirium,POD)的危险因素及预后。方法选择2018年2月至2023年3月我院收治的337例原发性肺癌切除术后入住重症监护病房患者,发生POD患者27例为观察组,无POD患者310例为对照组。收集临床资料,采用LASSO回归分析、多因素Logistic回归分析原发性肺癌切除术后POD患者的危险因素,记录POD患者发生情况与总生存期(overall survival,OS)、无病生存期(disease-free survival,DFS),分析POD患者发生情况与预后关系。结果合并脑血管疾病、鳞癌、年龄>71岁是POD发生的危险因素。风险评分简化公式为:1×(年龄>71岁)+1×(鳞癌)+1×(合并脑血管疾病)。预测POD发生风险受试者工作特征曲线(receiver operating characteristic curve,ROC)为0.840(95%CI:0.796~0.877),风险评分>1时,灵敏度、特异度分别为74.07%、85.48%。风险评分0~3分者POD发生率分别为1.50%、3.60%、22.41%、100.0%(P<0.05)。截至随访结束,337例肺癌术后复发147例(43.62%),死亡95例(28.19%),观察组27例中死亡6例(22.22%),对照组310例中死亡35例(11.29%)(P>0.05)。观察组DFS 10.00(4.00~43.00)个月,对照组DFS 10.00(3.00~91.00)个月(P>0.05)。观察组OS 33.00(8.00~68.00)个月短于对照组39.50(3.00~69.00)个月(P<0.05)。结论术后发生POD患者OS较短,预测原发性肺癌切除术后POD患者发生的风险评分具有临床意义。Objective To analyze the risk factors in postoperative delirium(POD)in primary lung cancer and predict prognosis.Methods All of 337 patients admitted to intensive care unit after primary lung cancer resection in our hospital from February 2018 to March 2023 were selected.27 patients with postoperative delirium were included in the observation group and 310 patients without postoperative delirium were included in the control group.Clinical data were collected.LASSO regression analysis and multiple Logistic regression were used to analyze the risk factors of postoperative delirium after primary lung cancer resection.Postoperative delirium occurrence,overall survival(OS)and disease-free survival(DFS)were recorded,and the relationship between postoperative delirium occurrence and prognosis was analyzed.Results The risk factors of postoperative delirium were cerebrovascular disease,squamous cell carcinoma and age>71 years old.The simplified formula of risk score is:1×(age>71 years)+1×(squamous cell carcinoma)+1×(cerebrovascular disease).The receiver operating characteristic curve(ROC)for predicting postoperative delirium risk was 0.840(95%CI:0.796~0.877),when risk score>1,sensitivity and specificity were 74.07% and 85.48%,respectively.The postoperative delirium incidence was 1.50%,3.60%,22.41% and 100.0%(P<0.05)in patients with risk scores 0 to 3,respectively.By the end of follow-up,147 cases(43.62%)had relapsed and 95 cases(28.19%)had died in 337 cases of lung cancer,there were 6 deaths(22.22%)among 27 patients in the observation group and 35 deaths(11.29%)among 310 patients in the control group.The DFS of the observation group was 10.00(4.00-43.00)months,and that of the control group was 10.00(3.00-91.00)months(P>0.05).The OS 33.00(8.00-68.00)months in the observation group was shorter than that in the control group 39.50(3.00-69.00)months(P<0.05).Conclusion The prediction of postoperative delirium risk score after primary lung cancer resection has clinical significance,and the patients with postoperative deliriu

关 键 词：原发性肺癌切除术 术后谵妄 风险评分 预后 

分 类 号：R734.2[医药卫生—肿瘤]