接受全主动脉弓人工血管置换并支架象鼻手术患者术后认知功能障碍影响因素及预测模型构建

Analysis of risk factors and establishment of a prediction model for early POCD patients after TAR+SET implantation

目的分析接受全主动脉弓人工血管置换并支架象鼻(全弓置换)手术的患者术后早期认知功能障碍(POCD)的相关影响因素,建立POCD预测模型并进行效能评估。方法 40例行全弓置换手术患者,根据简易精神状态量表(MMSE)评分分为POCD组(n=15)和NPOCD组(n=25),收集两组基线资料及术中数据,多因素Logistic回归分析早期POCD的影响因素,建立POCD预测模型并进行效能评估。结果两组性别、深低温停循环(DHCA)肛温、术中低血压、手术及机械通气时间比较,P均<0.05。多因素Logistic回归分析显示:术中低血压(OR=17.975,95%CI:1.292-250.081)和机械通气时间(OR=1.032,95%CI:1.000~1.065)是全弓置换手术后早期POCD的独立危险因素,DHCA肛温是其保护因素(OR=0.422,95%CI:0.188~0.948)。构建的早期POCD发生风险预测模型ROC曲线下面积(AUC)为0.856(95%CI:0.738~0.973),灵敏度为80.0%,特异度为79.2%。结论接受全弓置换手术的患者术后早期POCD的危险因素是术中低血压及机械通气时间,保护因素是DHCA肛温。建立的早期POCD发生预测模型对于接受全弓置换手术的患者术后早期POCD的预测效能较好。

Objective total arch replacement combined with stented elephant trunk(TAR+SET)implantation,and to establish a risk prediction model and to evaluate its effectiveness.Methods POCD group(n=15)and NPOCD group(n=25)according to the Mini-Mental State Examination(MMS)score. The basic information and intraoperative data were collected. The risk factors for early POCD were analyzed by multivariate Logistic regression analysis,and the risk prediction model was established and its effectiveness was evaluated.Results were statistically significant differences in gender,anal temperature of deep hypothermic circulatory arrest(DHCA),the occurrence of intraoperative hypotension,duration of operation,and mechanical ventilation between the two groups(all P<0. 05). Multivariate Logistic regression analysis showed that the occurrence of intraoperative hypotension(OR=17. 975,95%CI:1. 292-250. 081)and duration of mechanical ventilation(OR=1. 032,95%CI:1. 000-1. 065)were independent risk factors for early POCD after TAR+SET implantation,and the anal temperature of DHCA was a protective factor(OR=0. 422,95%CI:0. 188-0. 948). Area under ROC curve(AUC)of the established prediction model was 0. 856(95%CI:0. 738-0. 973),the sensitivity was 80. 0%,and specificity was 79. 2%.Conclusions and duration of mechanical ventilation are independent risk factors for early POCD patients receiving TAR+SET implantation,and anal temperature of DHCA is a protective factor. The established predictive model in this study is effective in predicting early POCD after TAR+SET implantation.