Abstract:

Objective To construct a risk prediction model of the postoperative delirium for patients with acute type A aortic dissection（ATAAD）,and to verify the prediction effect of the model. Methods A retrospective study was conducted among 245 adult patients undergoing aortic dissection surgery in the cardiac surgery department of a tertiary A hospital in Wenzhou from October 2020 to April 2021. According to the occurrence of postoperative delirium,the patients were divided into a delirium group （n=51） and a non-delirium group （n=194）,and the data of the 2 groups were compared. The risk prediction scoring model was constructed based on the multivariate logistic regression analysis of ATAAD postoperative delirium risk factors. The Hosmer-Lemeshow test was used to determine the model’s goodness of fit of the model,and the receiver operator characteristic curve （ROC） was used to test the model differentiation. The risk prediction model was validated by the prospective study with inclusion of 51 ATAAD patients admitted to the cardiac surgery department from July,2020 to June,2021. Results There were 6 factors included in the risk prediction model of patients with postoperative delirium,namely age over than 55.50 years（1 point）,male（1 point）,preoperative blood lactic acid value more than 1.85 mmol/L（1 point）,hypothermia cycle arrest time more than 36.50 minutes（1 point）,length of stay in CCU（cardiovascular intensive care unit）more than 8.50 days（2 points）,and other postoperative complications（1 point）. The Hosmer-Lemeshow test of the prediction scoring model showed that when P=0.393,the area under the ROC was 0.926. When the patient’s score was ≤4,the incidence of postoperative delirium in patients with ATAAD was≤15.63%;while it was≥5,the incidence was ≥50.00%. The sensitivity,specificity and accuracy of the risk stratification model were 76.47%,93.30% and 89.80%,respectively. The result of model verification shows that when the area under the ROC was 0.896,the Hosmer-Lemeshow test P=0.359. The sensitivity,specificity and accuracy of the risk stratification model were 75.00%,92.31% and 88.24%,respectively. Conclusion This risk prediction model provides an effective prediction effect,and it is simple and convenient to use in clinical application,which could be a reference for medical staff to take preventive treatment and nursing care.

Key words: Type A Aortic Dissection, Postoperative Delirium, Risk Score, Prediction Model, Perioperative Nursing

摘要：

目的 构建Stanford A型主动脉夹层患者术后谵妄风险预测评分模型,并验证其预测效果。 方法 选取2014年1月—2020年6月温州市某三级甲等综合性医院心脏外科收治的Stanford 245例A型主动脉夹层术后住院患者作为研究对象,回顾性收集相关资料。按术后是否发生谵妄分为谵妄组（n=51）和非谵妄组（n=194）,对两组资料进行比较,根据多因素Logistic回归分析结果建立风险预测评分模型。采用Hosmer-Lemeshow检验判断模型的拟合优度,受试者工作特征曲线下面积检验模型区分度。前瞻性纳入2020年10月—2021年4月心脏外科收治的51例Stanford A型主动脉夹层术后住院患者对模型进行验证。结果 Stanford A型主动脉夹层患者术后谵妄风险预测评分模型纳入年龄>55.50岁（1分）、男性（1分）、术前血乳酸值>1.85 mmol/L（1分）、深低温停循环时间>36.50 min（1分）、心脏重症监护室住院时间>8.50 d （2分）、术后合并其他并发症（1分）6个因素。该风险预测评分模型的Hosmer-Lemeshow检验结果显示P=0.393;受试者工作特征曲线下面积为0.926。当评分≤4分时,Stanford A型主动脉夹层患者术后谵妄发生率≤15.63%;当评为≥5分时,其发生率≥50.00%。该风险预测评分模型的灵敏度为76.47%,特异度为93.30%,准确率89.80%。模型验证结果显示,受试者工作特征曲线下面积为0.896,Hosmer-Lemeshow检验P=0.359,灵敏度为75.00%,特异度为92.31%,准确率为88.24%。 结论 Stanford A型主动脉夹层患者术后谵妄风险预测评分模型的预测效果良好,且临床使用便捷,可为医护人员采取预防性治疗和护理提供参考。

关键词: A型主动脉夹层, 术后谵妄, 风险评分, 预测模型, 围手术期护理