严重创伤患者谵妄发生风险预测模型的构建

doi:10.3761/j.issn.0254-1769.2020.06.002

摘要/Abstract

摘要：

目的探讨严重创伤患者发生谵妄的危险因素,构建列线图模型,以预测谵妄的发生。方法应用损伤严重程度评分量表,选取某三级甲等医院ICU收治的严重创伤患者437例,将谵妄组（n=142）和非谵妄组（n=295）的各项指标进行对比,通过单因素分析和多因素Logistic回归分析探索谵妄发生的独立危险因素,建立风险预测模型并构建列线图,采用Bootstrapping法验证模型预测效果。结果多因素Logistic回归分析显示,损伤严重程度评分>21分（OR=39.718）、急性生理与慢性健康状况评分>13分（OR=20.921）、ICU入住时间>9 d（OR=4.331）、Richmond躁动-镇静评分（每增加1分）（OR=1.823）和未使用右美托咪啶（OR=0.367）是谵妄发生的独立危险因素。根据上述5项危险因素构建的严重创伤患者谵妄发生列线图模型一致性指数为0.936,灵敏度为88.73%,特异度为85.42%,约登指数为0.742;外部模型验证结果,一致性指数为0.917,灵敏度为100%,特异度为84.37%。结论本研究构建的列线图能有效预测严重创伤患者住院期间谵妄的发生。

关键词: 严重创伤, 谵妄, 重症监护, 风险预测模型, 列线图

Abstract:

Objective To explore the risk factors of delirium in patients with severe trauma and develop a nomogram model to predict the occurrence of delirium. Methods 437 patients with severe trauma in ICU from a tertiary hospital were selected by Richmond Agitation-Sedation Scale（RASS）. The delirium group（n=142） and the non-delirium group（n=295） were compared to explore the independent risk factors of delirium through single factor analysis and multivariate logistic regression model. According to the selected independent risk factors,a risk prediction model was established and incorporated into the nomogram,and Bootstrapping method was adopted to verify the prediction effect of the model. Results After multivariate Logistic regression analysis,5 factors were included in the final regression model,including Injury Severity Score（ISS）（>21 points）（OR=39.718）,Acute Physiology and Chronic Health Evaluation（APACHEⅡ） score （>13 points）（OR=20.921）,hospital stay in ICU（>9 days）（OR=4.331）,RASS score（1 point for each increase）（OR=1.823） and dexmedetomidine（OR=0.367）. According to the above 5 risk factors,the prediction ability of delirium occurrence nomogram model of patients with severe trauma was useful,with the C-index of 0.936,the sensitivity of 88.73%,the specificity of 85.42% and the Youden index of 0.742. The results of the external model validation were C-index of 0.917,the sensitivity of 100%,and the specificity of 84.37%. Conclusion The nomogram can effectively predict the occurrence of delirium in patients with severe trauma during hospitalization. The model is valuable for predicting the risk of delirium.

Key words: Severe Trauma, Delirium, Intensive Care, Risk Prediction Model, Nomogram

吉云兰, 徐旭娟, 单君, 倪花, 汤丹丹, 吴亚琴, 薛慧萍, 姜岱山. 严重创伤患者谵妄发生风险预测模型的构建[J]. 中华护理杂志, 2020, 55(6): 811-816.

JI Yunlan, XU Xujuan, SHAN Jun, NI Hua, TANG Dandan, WU Yaqin, XUE Huiping, JIANG Daishan. Construction of risk prediction model of delirium occurrence in patients with severe trauma[J]. Chinese Journal of Nursing, 2020, 55(6): 811-816.

图/表 6

表1 严重创伤患者谵妄发生相关危险因素的比较（n=437）

表2 严重创伤患者发生谵妄的相关自变量赋值

表3 预测严重创伤患者发生谵妄的多因素Logistic回归分析

图1 严重创伤患者谵妄发生风险预测列线图

图2 模型构建组严重创伤患者谵妄发生风险预测的ROC曲线

图3 模型验证组严重创伤患者谵妄发生风险预测的ROC曲线

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