基于Nomogram构建心脏术后心脏重症监护室谵妄发生的预测模型  

Nomogram-based Predictive Modeling of the Occurrence of CCU Delirium in Postoperative Cardiac Patients

作　　者：魏钦香 金爱莲[1] 李慧[1] 房翠 WEI Qin-xiang;JIN Ai-lian;LI Hui;FANG Cui(Shangqiu First People's Hospital,Shangqiu 476100,Henan Province,China;Hebei Medical University,Shijiazhuang 050011,Hebei Province,China)

机构地区：[1]商丘市第一人民医院,河南商丘476100 [2]河北医科大学,河北石家庄050011

出　　处：《罕少疾病杂志》2025年第4期56-59,共4页Journal of Rare and Uncommon Diseases

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20191486);国家自然科学基金面上项目(81871749)。

摘　　要：目的通过Nomogram来构建心脏术后患者心脏重症监护室(CCU)谵妄发生的预测模型。方法回顾性分析2019年1月至2024年1月于本院行心脏体外循环术治疗的患者175例作为本次研究对象。根据术后谵妄的有无,患者被分为谵妄组(n=45)和非谵妄组(n=130)。比较患者临床资料,手术室指标,实验室指标和麻醉药物用量。采用logistics回归分析影响患者术后谵妄的独立危险因素,采用Nomogram构建术后谵妄的预测模型。结果谵妄组≥60岁患者,全麻插管人数占比要高于非谵妄组患者(P<0.05)。谵妄组患者手术时间,心脏复搏时间,术后住院时间和LDH水平要显著高于非谵妄组患者(P<0.05)。谵妄组患者丙泊酚用量要显著高于非谵妄组患者(P<0.05)。多因素logistics回归分析发现年龄,麻醉方案,手术时间,心脏复搏时间,术后住院时间,LDH和丙泊酚用量是导致患者术后出现谵妄的独立危险因素(P<0.05)。通过ROC曲线进行验证发现,模型的预测曲线为0.892,具有极高的临床价值。结论本研究开发的Nomogram模型能有效预测心脏手术后谵妄风险,识别关键危险因素。模型预测准确,对于指导临床预防和管理术后谵妄具有实际价值。Objective To construct a prediction model for the occurrence of delirium in cardiac intensive care unit(CCU)of postoperative cardiac patients by Nomogram.Methods:175 patients treated with cardiac extracorporeal circulation in our hospital from January 2019 to January 2024 were retrospectively analyzed as the subjects of this study.According to the presence or absence of postoperative delirium,patients were categorized into delirium group(n=45)and non-delirium group(n=130).The patients'clinical data,operating room indices,laboratory indices and anesthetic drug dosage were compared.Logistics regression was used to analyze the independent risk factors affecting patients'postoperative delirium,and Nomogram was used to construct a prediction model for postoperative delirium.Results In patients≥60 years old in the delirium group,the number of general anesthesia intubation accounted for a higher percentage than that of patients in the non-delirium group(P<0.05).The operation time,cardiac resuscitation time,postoperative hospitalization time and LDH level of patients in the delirium group were significantly higher than those in the non-delirium group(P<0.05).Propofol dosage was significantly higher in the delirium group than in the non-delirium group(P<0.05).Multifactorial logistic regression analysis revealed that age,anesthesia regimen,operation time,cardioversion time,postoperative hospitalization time,LDH and propofol dosage were independent risk factors for postoperative delirium(P<0.05).Validation by ROC curve revealed that the predictive curve of the model was 0.892,which is of high clinical value.Concluson The Nomogram model developed in this study was effective in predicting the risk of delirium after cardiac surgery and identifying key risk factors.The model predicts accurately and has practical value in guiding clinical prevention and management of postoperative delirium.

关 键 词：NOMOGRAM 心脏术后 CCU 谵妄 预测模型 

分 类 号：R322.11[医药卫生—人体解剖和组织胚胎学]