老年腹部手术患者术后亚谵妄综合征预测模型的构建

doi:10.3761/j.issn.0254-1769.2024.16.012

摘要/Abstract

摘要：

目的分析老年腹部手术患者术后亚谵妄综合征发生的影响因素并构建预测模型。方法采用便利抽样法，选取2022年2月—10月在四川省某三级甲等医院行腹部外科手术的497例老年患者作为调查对象，采用单因素和多因素Logistic回归分析探讨术后亚谵妄综合征发生的影响因素，使用R软件构建预测模型并绘制列线图。用受试者操作特征曲线下面积和Hosmer-Lemshow检验及校准图评价模型的区分度及校准度。结果多因素Logistic回归结果显示，年龄（OR=1.066）、社会功能活动问卷得分（OR=1.143）、术后使用镇痛泵（OR=5.811）、术后留置肛管（OR=2.276）和术后输血（OR=4.322）是术后亚谵妄综合征发生的独立影响因素。构建的预测模型在建模组和验证组中的P值均>0.05，受试者工作特征曲线下面积分别为0.734、0.691。结论该研究构建的老年腹部手术患者术后亚谵妄综合征预测模型具有较好的校准度和区分度，可以辅助临床医护人员识别术后亚谵妄综合征发生的高危患者，为制订预防和干预措施提供参考依据。

关键词: 老年人, 术后亚谵妄综合征, 腹部手术, 预测模型, 列线图, 护理

Abstract:

Objective To analyze the influencing factors of postoperative subsyndromal delirium in elderly patients undergoing abdominal surgery，and to develop a nomogram risk prediction model. Methods A convenience sampling method was used to select 497 elderly patients who underwent abdominal surgery in a tertiary hospital in Sichuan Province from February to October 2022. The risk prediction model and nomograms model were constructed using Logistic regression analysis and R software. The area under the subject’s working characteristic curve（AUC） and Hosmer-Lemshow test were used to evaluate the discrimination and calibration of the model. Results The results of Logistic regression showed that age（OR=1.066），functional activities（OR=1.143），patient controlled intravenous analgesia（OR=5.811），transanal drainage tube（OR=2.276） and postoperative blood transfusion （OR=4.322） were independent influences on the occurrence of postoperative subsyndromal delirium. The p-values of the prediction model in both the training and validation sets were greater than 0.05；the area under the ROC curves were 0.734 and 0.691；the model was presented in the form of nomogram. Conclusion The prediction model developed in this study has good discrimination and accuracy. It can be used to assist clinical staff in identifying patients at high risk of developing postoperative subsyndromal delirium and provide the reference for developing preventive and intervention measures.

Key words: Aged, Postoperative Subsyndromal Delirium, Abdominal Surgery, Prediction Model, Nomogram, Nursing Care

陈顺利, 刘琰, 陈静, 汤灵宇, 宋如, 蔡璐瑶, 郑思琳. 老年腹部手术患者术后亚谵妄综合征预测模型的构建[J]. 中华护理杂志, 2024, 59(16): 2001-2008.

CHEN Shunli, LIU Yan, CHEN Jing, TANG Lingyu, SONG Ru, CAI Luyao, ZHENG Silin. Construction of a predictive model for postoperative subsyndromal delirium in elderly patients undergoing abdominal surgery[J]. Chinese Journal of Nursing, 2024, 59(16): 2001-2008.

图/表 8

表1 老年腹部手术患者的一般资料（n=497）

Table 1 General information of elderly abdominal surgery patients（n=497）

表2 老年腹部手术患者发生术后亚谵妄综合征的单因素Logistic回归分析结果（n=459）

Table 2 Univariate Logistic regression analysis of postoperative subsyndromal delirium in elderly abdominal surgery patients（n=459）

表3 老年腹部手术患者发生术后亚谵妄综合征的多因素Logistic回归分析结果（n=459）

Table 3 Multivariable Logistic regression analysis of postoperative subsyndromal delirium in elderly abdominal surgery patients（n=459）

图1 老年腹部手术患者发生术后亚谵妄综合征预测模型在建模组中的受试者操作特征曲线

Figure 1 ROC curves of postopera-tive subsyndromal delirium predic-tion models in a training set for elderly abdominal surgery patients

图2 老年腹部手术患者发生术后亚谵妄综合征预测模型在建模组中的校准图

Figure 2 Calibration curve of postoperative subsyndromal delirium prediction models in a training set for elderly abdominal surgery patients

图3 老年腹部手术患者发生术后亚谵妄综合征预测模型在验证组中的受试者操作特征曲线

Figure 3 ROC curves of postope-rative subsyndromal delirium predic-tion models in a validation set for elderly abdominal surgery patients

图4 老年腹部手术患者发生术后亚谵妄综合征预测模型在验证组中的校准图

Figure 4 Calibration curve of postoperative subsyndromal delirium prediction models in a validation set for elderly abdominal surgery patients

图5 老年腹部手术患者发生术后亚谵妄综合征预测模型的列线图

Figure 5 Nomogram model for predicting the risk of postoperative subsyndromal delirium in elderly abdominal surgery patients

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