胃肠外科肿瘤患者术后谵妄风险预测模型的构建及效能评价

Construction and Efficacy Evaluation of Risk Prediction Model of Postoperative Delirium in Patients Undergoing Gastrointestinal Tumor Surgery

目的探讨胃肠外科肿瘤患者术后谵妄的危险因素,构建风险预测模型并验证。方法采用横断面调查研究法,选取2020年1—11月在西南医科大学附属医院接受胃肠道肿瘤手术的583例患者作为研究对象。采用自行设计的一般资料调查表、简易精神评估量表、抑郁自评量表、焦虑自评量表、数字疼痛评估量表收集相关资料,采用意识模糊评估方法(CAM)评估患者术后谵妄。将单因素分析中P<0.05的影响因素作为自变量拟合非条件Logistic回归分析患者术后谵妄的危险因素,采用Logistic回归构建风险预测模型并进行效能评价。结果胃肠外科肿瘤患者术后谵妄风险预测模型纳入既往排便不通畅、面罩吸氧、转入ICU、术前血钾浓度和术后疼痛评分共5个预测因子;验证结果显示,AUC=0.784(95%CI:0.735~0.833),灵敏度为83.2%,特异度为63.9%,约登指数为0.471。结论本研究构建的胃肠外科肿瘤患者术后谵妄风险预测模型具有一定的区分能力,可为护理人员早期识别术后谵妄高风险人群并采取针对性的干预措施提供参考。

Objective To explore the risk factors of postoperative delirium(POD)in patients undergoing gastrointestinal tumor surgery,and to construct a risk prediction model and evaluate its efficacy.Methods A crosssectional study was conducted.A total of 583 patients undergoing gastrointestinal tumor surgery in the Affiliated Hospital of Southwest Medical University from January 2020 to November 2020 were selected as the study subjects.Relevant data were collected by self-designed general information questionnaire,Mini-Mental State Examination(MMSE),Selfrating Depression Scale(SDS),State-Trait Anxiety Inventory(STAI)and Number Rating Scale(NRS).POD of patients was evaluated by confusion assessment method(CAM).The influencing factors with statistical differences(P<0.05)in univariate analysis were used as independent variables to fit the risk factors of POD in patients with unconditional logistic regression analysis.A predictive model of POD in patients undergoing gastrointestinal tumor surgery was constructed and its efficacy was evaluated by Logistic regression.Results Five predictors including previous constipation,use of mask oxygen inhalation,transfer to ICU,preoperative hypokalemia and postoperative pain score were included in the risk prediction model of POD in patients undergoing gastrointestinal tumor surgery.The validation results showed that the AUC of the risk prediction model was 0.784(95%CI:0.735—0.833),the sensitivity was 83.2%,the specificity was 63.9%,and the Yoden index was 0.471.Conclusion The risk prediction model of POD in patients undergoing gastrointestinal tumor surgery constructed in this study has certain ability to distinguish between POD and non-POD patients,which can provide reference for nurses to identify patients at high risk of POD early and take targeted intervention measures.