|
| 老年髋关节手术患者术后谵妄的危险因素分析和预测模型的建立 |
| Risk factor analysis and prediction modeling of postoperative delirium in elderly hip surgery patients |
| 投稿时间：2025-06-05 修订日期：2025-12-04 |
| DOI： |
| 中文关键词: 术后谵妄、预测模型、髋关节置换 |
| 英文关键词: postoperative delirium, predictive modeling, hip replacement |
| 基金项目:2022YXNS017（济宁市重点研发计划） |
|
| 摘要点击次数: 64 |
| 全文下载次数: 0 |
| 中文摘要: |
| 目的：老年髋关节手术患者术后谵妄（POD）发生率较高，与不良预后密切相关，但目前缺乏针对该人群的精准预测工具。本研究旨在构建一种老年患者髋关节术后谵妄的模型，以早期识别高危患者。方法：采用回顾性队列研究设计，最终共纳入2023年1月至2023年12月共203例老年髋关节手术患者。收集患者术前、术中相关临床资料。采用意识模糊评估量表（CAM）评估患者术后1-7天谵妄的发生情况。通过对两组临床指标进行差异性分析，将P值＜0.2的相关因素纳入模型，并建立logistic逻辑多因素回归模型，并通过AUC-ROC、校准曲线和列线图分析评估模型性能。结果：203例患者中有23（11.33%）人发生了术后谵妄，通过差异性分析将P＜0.2的因素如年龄、BMI、合并糖尿病、失血量、IF-17A，饮酒史，COPD史一并纳入多因素回归模型，发现年龄、低BMI、合并糖尿病、失血量是POD独立危险因素。ROC曲线显示，该模型预测老年髋关节手术术后谵妄风险的曲线下面积（AUC）未0.83（95%CI0.75-0.95），校准曲线显示预测曲线与标准曲线基本拟合，列线图提示术中年龄、出血量、BMI、糖尿病、IL-17A对模型贡献最大。结论：老年髋关节置换手术术后谵妄的主要危险因素为年龄、低BMI、合并糖尿病、失血量，基于以上因素建立的模型可有效预测老年髋关节术后谵妄发生的危险，未来需更多外部验证以推广应用。 |
| 英文摘要: |
| Objective: Elderly patients undergoing hip surgery have a high incidence of postoperative delirium (POD), which is closely associated with poor prognosis, but there is a lack of accurate prediction tools for this population. This study aimed to construct a model for postoperative delirium in elderly patients with hip surgery for early identification of high-risk patients. Methods: A retrospective cohort study design was used, and a total of 203 elderly hip surgery patients from January 2023 to December 2023 were finally included. Patients' preoperative and intraoperative-related clinical data were collected. The Ambiguity of Consciousness Assessment Scale (CAM) was used to assess the occurrence of delirium in patients from 1 to 7 days after surgery. By analyzing the difference between the clinical indicators of the two groups, the relevant factors with a P value <0.2 were included in the model and a logistic multifactorial regression model was established, and AUC-ROC, calibration curves, and columnar plot analysis assessed the performance of the model. Result: Postoperative delirium occurred in 23 (11.33%) of 203 patients. Factors with P < 0.2 such as age, BMI, comorbid diabetes mellitus, blood loss, IF-17A, history of alcohol consumption, and history of COPD were included in the multifactorial regression model along with the factors with P < 0.2 by analysis of variance and age, low BMI, comorbid diabetes mellitus, and blood loss were found to be the independent risk factors of POD. The ROC curves showed that the area under the curve (AUC) of the model predicting the risk of postoperative delirium in elderly hip surgery was not 0.83 (95% CI 0.75-0.95). The calibration curve showed that the prediction curve was fitted to the standard curve. The column line graph suggested that intraoperative age, blood loss, BMI, diabetes, and IL-17A contributed the most to the model. Conclusion: The main risk factors for postoperative delirium in elderly hip arthroplasty are age, low BMI, comorbid diabetes mellitus, and blood loss, and the model based on the above factors can effectively predict the risk of postoperative delirium in the elderly, and more external validation is needed in the future to promote the application. |
|
View Fulltext
查看/发表评论 下载PDF阅读器 |
|
|
|
