心脏移植术后谵妄发生现状及核心因素的决策树研究  

Decision tree study of delirium occurrence and core factors after heart transplantation

作　　者：刘晶晶 孙肖艳 LIU Jingjing;SUN Xiaoyan(Cardiac Surgery Intensive Care Unit,Zhengzhou Seventh People's Hospital,Zhengzhou 450000,CHN)

机构地区：[1]郑州市第七人民医院心脏外科重症监护室,郑州450000

出　　处：《河南大学学报(医学版)》2025年第1期34-41,共8页Journal of Henan University:Medical Science

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190132)。

摘　　要：目的:探讨心脏移植术后谵妄(POD)发生现状及核心因素,并构建其决策树模型。方法:选取2022年1月至2023年12月某医院收治的100例行心脏移植术患者为研究对象,依据心脏移植术后是否发生谵妄情况分为两组,分别为POD组与非POD组,分析心脏移植术后谵妄发生现状及核心因素,采用SPSS Modeler软件构建心脏移植术后发生谵妄的决策树模型,并分析其预测效能。结果:本研究100例行心脏移植术的患者中,发生术后谵妄的患者31例,术后谵妄发生率为31.00%(31/100);多因素Logistic回归分析结果显示,低心排综合征、卒中史、术后血红蛋白(Hb)<100 g/L、年龄≥65岁、术中出血量≥1000mL、体外循环时间等是心脏移植术后发生谵妄的危险因素(P<0.05);构建了心脏移植术后发生谵妄的决策树模型,决策树模型共3层,11个节点,模型选择了年龄、术后Hb、低心排综合征、术中出血量等4个临床特征作为模型的节点,其中重要性排名第一的预测因子是年龄;心脏移植术后发生谵妄的决策树模型AUC是0.900(95%CI:0.824~0.951),Logistic回归模型的AUC是0.810(95%CI:0.720~0.882),决策树模型与Logistic回归模型的delong检验结果为Z=2.334,P=0.020。结论:低心排综合征、卒中史、术后Hb<100 g/L、年龄≥65岁、术中出血量≥1000 mL、体外循环时间等是心脏移植术后发生谵妄的危险因素,本研究基于决策树法构建的心脏移植术后谵妄发生的模型预测效能较好,可为心脏移植术后谵妄发生的预防提供一定的理论参考。Objective:To investigate the present situation and core factors of delirium after heart transplantation(POD),and construct its decision tree model.Methods:The study selected 100 patients who underwent heart transplantation at the Seventh People's Hospital of Zhengzhou City from January 2022 to December 2023 as the research subjects.Based on whether postoperative delirium occurred after heart transplantation,the patients were divided into two groups:the POD group and the non-POD group.The current situation and core factors of postoperative delirium after heart transplantation were analyzed.The decision tree model for predicting postoperative delirium was constructed using SPSS Modeler software,and its predictive performance was analyzed.Results:Among the 100 patients who underwent heart transplantation in this study,31 patients experienced postoperative delirium,resulting in a postoperative delirium incidence rate of 31.00%(31/100).The results of the multivariate logistic regression analysis showed that factors such as low cardiac output syndrome,history of stroke,postoperative Hb<100 g/L,age≥65 years,intraoperative blood loss≥1000 mL,and cardiopulmonary bypass time were risk factors for postoperative delirium after heart transplantation(P<0.05).A decision tree model for predicting postoperative delirium after heart transplantation was constructed.The decision tree model had a total of 3 layers and 11 nodes.The model selected 4 clinical features,including age≥65 years,postoperative Hb<100 g/L,low cardiac output syndrome,and intraoperative blood loss≥1000 mL,as the nodes of the model.Among them,the most important predictor was age≥65 years.The area under the curve(AUC)of the decision tree model for predicting postoperative delirium after heart transplantation was 0.900(95%CI:0.824-0.951),while the AUC of the logistic regression model was 0.810(95%CI:0.720-0.882).The DeLong test between the decision tree model and the logistic regression model showed a result of Z=2.334,P=0.020.Conclusion:Low heart rate sy

关 键 词：心脏移植术 谵妄 影响因素 决策树模型 

分 类 号：R541[医药卫生—心血管疾病]