Abstract:

Objective To investigate the independent influences on the occurrence of ICU Acquired Weakness （ICU-AW） in elderly patients undergoing third- and fourth-level surgeries，to construct a prediction model and draw a column-line diagram，and to internally validate the model. Methods A convenience sampling method was used to select 186 elderly patients undergoing tertiary and quaternary surgeries who were hospitalized in 3 tertiary A hospitals in Beijing from May to December 2022 as the study subjects. Single-factor and multifactor logistic regression were used to analyze the risk factors for ICU-AW in elderly patients undergoing third- and fourth-degree surgeries.A risk prediction model was established and the model was visualized by drawing a column-line diagram，and the receiver operator characteristic curve（ROC） and the Hosmer-Lemeshow tests were applied to verify the predictive effect of the model. Results ICU-AW occurred in 40 of 186 cases in the modeling group，with an incidence rate of 21.5%. The results of univariate analysis showed that the 2 groups of preoperative physiology score and surgical severity score included in the physiology and surgical severity scoring system，age，presence of cardiac disease，hemoglobin（within 24 h of admission to the ICU），blood urea nitrogen（within 24 h of admission to the ICU），blood creatinine（within 24 h of admission to the ICU），presence of braking，mode of establishment of mechanical ventilation，presence of nutritional therapy，number of sedative or analgesic drugs used，whether vasoactive drugs were used，whether diuretics were used，and the level of hemoglobin，blood urea nitrogen and blood creatinine within 24 h after admission to ICU the difference is statistically significant（P<0.05）. The results of multifactorial logistic regression analysis showed that preoperative physiology scores included in the physiology and surgical severity scoring system，the presence of cardiac disease，the presence of braking，the presence of nutritional therapy，and the number of sedative or analgesic medications used were the predictors of the occurrence of ICU-AW in elderly patients undergoing third- and fourth-degree surgeries（OR were 1.364，2.344，5.568，5.823，1.109，all P<0.05）. The above 5 factors were plotted as independent variables in a column-line graph，and the area under the ROC curve of the model was 0.859（95%CI 0.793~0.924），with an optimal critical value of 0.156，a sensitivity of 0.875，a specificity of 0.705，and a Hosmer-Lemeshow goodness-of-fit test of χ²=3.906，P=0.865，Brier score of 0.109，and a decision analysis curve indicating that patients could benefit. Conclusion The predictive effect of the constructed model is good，and it can be used as a reference for early and rapid identification of the risk of ICU-AW in elderly patients undergoing third-and fourth-degree surgeries by clinical staff，and timely provision of preventive intervention programs.

Key words: Elderly, Intensive Care Unit, Acquired Weakness, Prediction Model, Risk Assessment, Nursing Care

摘要：

目的 调查接受三四级手术后老年患者发生ICU获得性衰弱（intensive care unit acquired weakness，ICU-AW）的独立影响因素，构建预测模型并绘制列线图，对模型进行内部验证。 方法 采用便利抽样法，选取2022年5月—12月在北京市3所三级甲等医院住院的186例三四级手术老年患者作为调查对象。采用单因素和多因素Logistic回归分析三四级手术老年患者发生ICU-AW的危险因素，建立风险预测模型并绘制列线图将模型可视化，应用受试者操作特征曲线（receiver operating characteristic，ROC）和Hosmer-Lemeshow检验验证模型的预测效果。 结果 建模组186例中有40例发生ICU-AW，发生率为21.5%。单因素分析结果显示，两组生理学和手术严重度评分系统包含的术前生理学评分和手术严重度评分、年龄、是否患心脏疾病、是否制动、机械通气建立方式、是否接受营养治疗、使用镇静镇痛药物次数、是否使用血管活性药、是否使用利尿剂以及患者入ICU 24 h内的血红蛋白水平、血尿素氮水平、血肌酐水平比较，差异具有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，生理学和手术严重度评分系统包含的术前生理学评分、是否患心脏疾病、是否制动、是否接受营养治疗、使用镇静镇痛药物次数是三四级手术老年患者发生ICU-AW的独立影响因素，OR值分别为1.364、2.344、5.568、5.823、1.109。以上5个因素作为自变量绘制列线图，模型的ROC曲线下面积为0.859，95%CI为0.793~0.924，最佳临界值为0.156，灵敏度为0.875，特异度为0.705，Hosmer-Lemeshow拟合优度检验显示，χ²=3.906，P=0.865，布里尔评分为0.109，决策分析曲线表明患者能够获益。 结论 构建的模型预测效果良好，可为临床医护人员早期快速识别接受三四级手术的老年患者发生ICU-AW的风险、及时提供预防性干预方案提供参考。

关键词: 老年人, 重症监护病房, 获得性衰弱, 预测模型, 风险评估, 护理