老年髋膝关节置换术后患者亚谵妄综合征风险预测模型的构建及验证  

Development and validation of a prediction model for subsyndromal delirium in elderly patients after hip or knee replacement surgery

作　　者：马欣雨 王爽 程环毓 王姣姣 高明阳 祝筠 Ma Xinyu;Wang Shuang;Cheng Huan yu;Wang Jiaojiao;Gao Mingyang;Zhu Yun(Party Committee Office,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东第一医科大学附属省立医院党委办公室,山东济南250021 [2]山东第一医科大学附属省立医院关节外科,山东济南250021 [3]山东大学护理与康复学院

出　　处：《护理学杂志》2025年第8期31-35,共5页Journal of Nursing Science

摘　　要：目的探讨老年髋膝关节置换术后患者亚谵妄综合征发生现状及影响因素,构建预测模型,为临床预防及管理提供参考。方法采用便利抽样法,选取415例行择期髋膝关节置换术的老年患者进行前瞻性研究;通过LASSO回归和多因素logistic回归分析影响因素,使用R软件构建预测模型并绘制列线图。选取121例老年患者(验证组)进行验证。结果建模组亚谵妄综合征发生率为42.41%。术前简易智能精神状态检查量表得分(OR=0.870)、术后转入ICU(OR=3.965)、C-反应蛋白(OR=1.020)和疼痛评分(OR=2.642)是老年髋膝关节置换术后患者发生亚谵妄综合征的影响因素(均P<0.05)。构建的预测模型ROC曲线下面积为0.831,灵敏度为0.716,特异度为0.824。Bootstrap内部验证和验证组ROC曲线下面积分别为0.826和0.812;临床决策曲线显示该模型具有一定的临床实用价值。结论老年髋膝关节置换术后患者亚谵妄综合征发生率较高,构建的风险预测模型预测效能良好,有利于针对危险因素制订干预策略。Objective To analyze the prevalence and influencing factors of subsyndromal delirium(SSD)in elderly patients after elective hip or knee replacement,to construct a risk prediction model,and to provide reference for prevention and management of SSD.Methods This was a prospective cohort study of 415 patients undergoing elective hip or knee replacement in a single tertiary hospital.LASSO regression and multivariate logistic regression were used to analyze the influencing factors.The nomogram prediction model was constructed using R software and validation was performed in 121 patients.Results The incidence of SSD in model development group was 42.41%.The Mini-Mental State Examination score before the surgery(OR=0.870),transfer to ICU after the surgery(OR=3.965),postoperative C-reactive protein(OR=1.020),and postoperative pain score(OR=2.642)were factors associated with SSD(all P<0.05).The nomogram predication model had good performance,with the area under the ROC curve(AUC)of 0.831,sensitivity of 0.716,and specificity of 0.824.The AUC of Bootstrap internal validation and of validation group was 0.826 and 0.812 respectively.The clinical decision curve showed that the model had good clinical net benefit.Conclusion SSD is prevalent in elderly patients undergoing elective hip or knee replacement,and the nomogram prediction model has satisfactory predictive efficacy,which facilitates medical staff to develop targeted intervention.

关 键 词：老年人 髋膝关节置换术 亚谵妄综合征 认知功能 衰弱 疼痛 预测模型 护理 

分 类 号：R473.6[医药卫生—护理学]