《中国康复理论与实践》

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (3): 340-345.doi: 10.3969/j.issn.1006-9771.2022.03.010

• 临床研究 • 上一篇    下一篇

重症监护室中老年患者术后谵妄影响因素分析及风险预测模型建立与评价

葛章伟1,黄馨1(),刘正东1,张敏1,张家奎2   

  1. 1. 安徽医科大学附属六安医院重症医学科,安徽六安市 237005
    2. 合肥市第二人民医院血液内科,安徽合肥市 230011
  • 收稿日期:2021-09-02 修回日期:2021-12-27 出版日期:2022-03-25 发布日期:2022-03-31
  • 通讯作者: 黄馨 E-mail:462011752@qq.com
  • 基金资助:
    安徽省高校自然科学研究重点项目(KJ2019A0274)

Factors related to post-operative delirium in middle-aged and elderly patients in intensive care unit and risk prediction model

GE Zhangwei1,HUANG Xin1(),LIU Zhengdong1,ZHANG Min1,ZHANG Jiakui2   

  1. 1. Department of Critical Care Medicine, Lu'an Hospital of Anhui Medical University, Lu'an, Anhui 237005, China
    2. Department of Hematology, Hefei Second People's Hospital, Hefei, Anhui 230011, China
  • Received:2021-09-02 Revised:2021-12-27 Published:2022-03-25 Online:2022-03-31
  • Contact: HUANG Xin E-mail:462011752@qq.com
  • Supported by:
    Key Project of Natural Science Research in Universities of Anhui Province No(KJ2019A0274)

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摘要： 目的 分析引发重症监护室(ICU)中老年患者术后谵妄的影响因素并构建风险预测模型。方法 选取2018年1月至2021年2月安徽医科大学附属六安医院ICU中老年术后患者112例,转入ICU的第2天采用ICU意识模糊评估法(CAM-ICU)评估患者,根据是否发生谵妄分为谵妄组(n = 52)和非谵妄组(n = 60)。采用单因素分析比较两组间临床资料的差异,采用Logistic回归筛选术后谵妄的危险因素,并构建风险预测模型,绘制接受者操作特征(ROC)曲线评价预测效能。结果 Logistic多因素回归分析显示：急性生理和慢性健康评分(APACHE II评分) (OR = 1.424,95%CI 1.204~1.685, P < 0.001)、ICU睡眠质量评分(OR = 1.432,95%CI 1.159~1.770, P < 0.001)、术后氧合指数≤ 300 (OR = 4.485,95%CI 1.644~12.240, P = 0.001)是ICU术后谵妄的独立影响因素。联合检测因子模型为：logit(P) = -11.381+0.354X1(APACHE II评分,截值16分)+0.359X2(ICU睡眠质量评分,截值13分)+1.501X3(术后氧合指数≤ 300),联合检测因子的敏感性为79.2%,特异性为79.7%,ROC曲线下面积为0.866 (95%CI 0.801~0.930),高于各因子的曲线下面积(P < 0.05)。结论 基于Logistic回归模型构建的联合检测因子能预测ICU中老年患者术后谵妄的发生。

关键词: 重症监护, 术后, 谵妄, 影响因素, 中老年

Abstract: Objective To analyze the influencing factors of post-operative delirium (POD) in middle-aged and elderly patients in intensive care unit (ICU) and construct risk prediction model for it.Methods A total of 112 middle-aged and elderly postoperative patients in the ICU of Lu'an Hospital of Anhui Medical University from January, 2018 to February, 2021 were selected. On the second day after the operation, they were transferred to ICU, and assessed with the Confusion AssessmentMethod for Intensive Care Unit (CAM-ICU). The patients were divided into delirium group (n = 52) and non-delirium group (n = 60) according to assessment. Univariate analysis was used to compare the differences in clinical data between the two groups, and multivariate Logistic regression analysis was used to screen the independent influencing factors to construct risk prediction model. Receiver operating characteristic (ROC) curve was used to evaluate prediction performance. Results Multivariate logistic regression analysis showed Acute Physiology and Chronic Health Evaluation II score (APACHE II score) (OR = 1.424, 95%CI 1.204 to 1.685, P < 0.001), ICU sleep quality score (OR = 1.432, 95%CI 1.159 to 1.770, P < 0.001), and postoperative oxygenation index ≤ 300 (OR = 4.485, 95%CI 1.644 to 12.240, P = 0.001) were independent influencing factors of postoperative delirium in ICU. The prediction model was: logit(P) = -11.381+0.354X1 (APACHE II score, cut-off value 16)+0.359X2 (ICU sleep quality score, cut-off value 13)+1.501X3 (postoperative oxygenation index ≤ 300), with the sensitivity and specificity of 79.2% and 79.7% respectively. The area under the ROC curve was 0.866 (95%CI 0.801 to 0.930), more than those of the factors alone (P < 0.05). Conclusion The prediction model based on Logistic regression can predict the occurrence of postoperative delirium in middle-aged and elderly patients in ICU.

Key words: intensive care unit, postoperative, delirium, influencing factors, middle-aged and elderly