| 刘娜娜,刘洋,江海滨,刘群,张成栋.老年髋关节置换术后患者谵妄的危险因素分析和预测模型建立[J].济宁医学院学报,2026,49(5):425-429 |
| 老年髋关节置换术后患者谵妄的危险因素分析和预测模型建立 |
| Risk factor analysis and prediction modeling of postoperative delirium in elderly hip surgery patients |
| 投稿时间：2025-06-05 |
| DOI：10.3969/j.issn.1000-9760.2026.05.007 |
| 中文关键词: 术后谵妄 预测模型 髋关节置换 老年人 危险因素 |
| 英文关键词: Postoperative delirium Predictive modeling Hip replacement Elderly Risk factors |
| 基金项目:济宁市重点研发计划（2022YXNS017） |
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| 中文摘要: |
| 目的 老年髋关节置换患者术后谵妄（postoperative delirium,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POD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 d谵妄的发生情况。通过分析两组临床指标，将P＜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POD，通过差异性分析将P＜0.2的因素如年龄、BMI、MMSE评分、糖尿病、术中失血量、IL-17A，饮酒史，COPD史纳入多因素回归模型，发现年龄（OR=1.25，95%CI：1.04~1.50）、糖尿病（OR=3.77，95%CI：1.10~12.99）、BMI（OR=0.78，95%CI：0.65~0.93），术中失血量（OR=1.01，95%CI：1.01~1.02）水平是POD发生的独立影响因素（P＜0.05）。ROC曲线显示，该模型预测老年髋关节手术POD风险的曲线下面积（AUC）为0.80（95%CI：0.70～0.91），校准曲线显示预测曲线与标准曲线基本拟合，列线图提示BMI贡献最大，其余依次为术中失血量、年龄、糖尿病。结论 老年髋关节置换手术POD的主要危险因素为年龄、低BMI、合并糖尿病、术中失血量，基于以上因素建立的模型可有效预测老年髋关节POD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 exhibit 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 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.Confusion Assessment Method (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 multifactorial logistic 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,MMSE,comorbid diabetes mellitus,blood loss,IL-17A,history of alcohol consumption,and history of COPD were included in the multifactorial regression model, and age,low BMI,comorbid diabetes mellitus,and blood loss were identified as 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 0.80 (95%CI:0.70~0.91).The calibration curve showed that the prediction curve was fitted to the standard curve.The column line graph suggested BMI contributed the most,followed by blood loss,age and diabetes.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 further external validation is needed in the future to promote the application. |
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