保健医学研究与实践2024，Vol.21Issue(9)：44-49,55,7.DOI:10.11986/j.issn.1673-873X.2024.09.07
高龄骨科手术患者发生术后谵妄的影响因素及风险预测模型构建
Influencing factors and risk prediction model for postoperative delirium in elderly orthopedic surgery patients
摘要
Abstract
Objective To explore the independent risk factors for postoperative delirium(POD)in elderly orthopedic surgery patients and to construct a stepwise regression-based risk prediction model,in order to provide support for clinical treat-ment.Methods A total of 55 elderly orthopedic surgery patients with POD were selected as the delirium group(POD group),and 55 elderly orthopedic surgery patients without POD were selected as the non-delirium group.All patients were admitted to the First Hospital of Qinhuangdao from January 2022 to January 2024.Clinical data,including demographic in-formation,comorbidities,American Society of Anesthesiologists(ASA)classification,preoperative cognitive dysfunction,preoperative malnutrition,lifestyle habits(smoking,drinking),surgical information,and laboratory results,were extracted from the hospital's electronic medical record system.Multivariate stepwise regression analysis was used to identify the inde-pendent risk factors for POD in elderly orthopedic surgery patients and to construct a risk prediction model.The model's predictive performance was evaluated using receiver operating characteristic(ROC)curves.Results The multivariate step-wise regression analysis revealed that ASA classification Ⅲ(OR=17.581,95％CI:5.258-58.790),preoperative cogni-tive dysfunction(OR=15.743,95％CI:1.266-195.716),intraoperative hypoxemia(OR=16.040,95％CI:1.552-165.821),and preoperative albumin level＜35 g/L(OR=4.325,95％CI:1.527-12.250)were independent risk factors for POD in elderly orthopedic surgery patients(P＜0.05).The Hosmer-Lemeshow test showed good calibration for the constructed risk prediction model(x2=0.402,P=0.999).The ROC curve results indicated that the area under the curve(AUC)for predicting POD in elderly orthopedic surgery patients was 0.863(95％CI:0.794-0.932),with a sensitivity of 81.80％and a specificity of 78.20％.Conclusion ASA classification Ⅲ,preoperative cognitive dysfunction,intraoperative hypoxemia,and low preoperative albumin levels are independent risk factors for the occurrence of POD in elderly orthopedic surgery patients.The prediction model constructed based on these factors demonstrates good predictive efficacy for POD oc-currence.关键词
骨科手术/高龄/术后谵妄/风险模型Key words
Orthopedic surgery/Elderly/Postoperative delirium/Risk model分类
医药卫生引用本文复制引用
唐莲莲,赵立坤,田英慧,李佳,岳淑玲,李铁松,陈晓敏..高龄骨科手术患者发生术后谵妄的影响因素及风险预测模型构建[J].保健医学研究与实践,2024,21(9):44-49,55,7.基金项目
河北省医学科学研究课题计划项目(20221612) （20221612）
河北省秦皇岛市科学技术研究与发展计划项目(2017C045). （2017C045）
