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

doi:10.3969/j.issn.1006-9771.2022.03.010

Abstract

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

GE Zhangwei,HUANG Xin,LIU Zhengdong,ZHANG Min,ZHANG Jiakui. Factors related to post-operative delirium in middle-aged and elderly patients in intensive care unit and risk prediction model[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(3): 340-345.

Figures/Tables 6

References 32

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因素	谵妄组 (n = 52)	非谵妄组 (n = 60)	χ²/t值	P值
性别/n			0.597	0.440
男性	31	40
女性	21	20
年龄/岁	63.27.±9.99	59.4±10.23	2.001	0.048
体质量指数/kg·m^-2	20.2±4.5	19.9±4.6	0.219	0.827
吸烟史/n	24	30	0.165	0.685
饮酒史/n	22	25	0.005	0.945
基础病/n
高血压	26	35	0.780	0.377
糖尿病	7	9	0.054	0.817
冠心病	8	11	0.172	0.678
呼吸系统疾病	4	7	0.497	0.481
肝肾功能不全	3	4	0.038	0.845

因素	谵妄组 (n = 52)	非谵妄组 (n = 60)	χ²/t值	P值
麻醉方式/n			4.099	0.043
非全麻	23	38
全麻	29	22
麻醉时间/n			4.099	0.043
≤ 3 h	23	38
> 3 h	29	22
手术部位/n			3.400	0.493
头颅	3	8
胸部	7	5
腹部	18	16
四肢	18	21
其他	6	10
手术时间/n			6.135	0.013
≤ 2 h	19	36
> 2 h	33	24
术中失血量/n			4.099	0.043
≤ 300 ml	23	38
> 300 ml	29	22
术中补液量/n			0.090	0.765
≤ 2000 ml	24	26
> 2000 ml	28	34

因素	谵妄组 (n = 52)	非谵妄组 (n = 60)	χ²/t值	P值
APACHEⅡ评分	17.10±3.86	13.50±2.94	5.59	< 0.001
机械通气时间/n			0.447	0.504
≤ 48 h	31	32
> 48 h	21	28
使用镇痛药/n	45	48	0.845	0.358
使用镇静药/n	24	40	4.786	0.029
术后氧合指数/n			17.920	< 0.001
≤ 300 mmHg	39	21
> 300 mmHg	13	39
低蛋白血症/n	22	31	0.979	0.322
血红蛋白/n			2.125	0.346
< 60 g/L	20	19
60~90 g/L	18	17
> 90 g/L	14	24
停留时间/n			13.867	< 0.001
≤ 7 d	13	36
> 7 d	39	24
睡眠质量评分	15.23±2.71	12.72±2.85	4.758	< 0.001

影响因素	回归系数	标准差	χ²值	OR	95%CI	P值
APACHEⅡ评分	0.354	0.086	16.968	1.424	1.204~1.685	< 0.001
ICU睡眠质量评分	0.359	0.108	11.051	1.432	1.159~1.770	< 0.001
术后氧合指数≤ 300 mmHg	1.501	0.512	8.585	4.485	1.644~12.240	0.003

影响因素	最佳截值	敏感性/%	特异性/%	AUC	SE	95%CI	P值
APACHEⅡ评分	16	73.6	63.4	0.778^a	0.044	0.692~0.864	< 0.001
ICU睡眠质量评分	13	58.5	86.4	0.717^a	0.048	0.623~0.812	< 0.001
术后氧合指数≤ 300 mmHg	-	73.6	59.3	0.690^a	0.051	0.591~0.789	0.001
联合检测因子	-	79.2	79.7	0.866	0.033	0.801~0.930	< 0.001

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

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