心脏手术衰弱老年患者术后谵妄的危险因素及其预测模型的建立

Risk factors for postoperative delirium in frail elderly patients undergoing cardiac surgery and development of a prediction model

目的:筛选心脏手术衰弱老年患者术后谵妄(POD)的危险因素,并建立预测模型。方法:回顾性收集2022年1月至2022年6月行体外循环(CPB)心脏手术老年患者的病历资料,年龄≥65岁,ASA分级Ⅲ或Ⅳ级,衰弱指数(FI)评分>0.25分。根据术后7 d内POD发生情况,分为POD组和非POD组。收集患者性别、年龄、简易智力状态检查(MMSE)评分、既往史、术前实验室检查结果、手术时间、术中脑氧饱和度(rSO_(2))、rSO_(2)基线值(rSO_(2)baseline)、CPB前、中、后rSO_(2)最低值(CPB_(1)rSO_(2lowest)、CPB_(2)rSO_(2lowest)、CPB_(3)rSO_(2lowest))以及rSO_(2)较基线值下降最大幅度(CPB_(1)rSO_(2decrease)、CPB_(2)rSO_(2decrease)、CPB_(3)rSO_(2decrease))等。采用多因素logistic回归分析法筛选POD的危险因素,建立受试者工作特征曲线(ROC曲线)评价预测价值。结果:共纳入患者130例,POD组32例,非POD组98例,POD发生率24.6%。多因素logistic回归分析结果显示:CPB_(2)rSO_(2decrease)、CPB_(2)rSO_(2lowest)及手术时间是POD的独立危险因素(P<0.05)。CPB_(2)rSO_(2decrease)>11.2%预测POD的ROC曲线下面积(95%可信区间)为0.655(0.533~0.778)、灵敏度和特异度分别为68.9%和62.9%;手术时间>237.5 min预测POD的ROC曲线下面积(95%可信区间)为0.751(0.652~0.849),灵敏度和特异度分别为62.5%和78.6%。结论:CPB_(2)rSO_(2decrease)、CPB_(2)rSO_(2lowest)及手术时间是心脏手术衰弱老年患者POD的独立危险因素;CPB_(2)rSO_(2decrease)和手术时间均可有效预测POD的发生。

Objective To identify the risk factors for postoperative delirium(POD)in frail elderly patients undergoing cardiac surgery and develop a ROC prediction model.Methods The medical records of patients of either sex,aged≥65 yr,of American Society of Anesthesiologists Physical Status classificationⅢorⅣ,with frailty index score>0.25,underwent open heart surgery under cardiopulmonary bypass(CPB)from January 2022 to June 2022,were collected retrospectively.The patients were divided into POD group and non-POD group according to POD occurred within 7 days after operation.Clinical information such as gender,age,Mini-mental State Examination score,past medical history,results of the laboratory test before surgery,operation time,cerebral oxygen saturation(rSO_(2)),rSO_(2)baseline(rSO_(2)baseline),lowest intraoperative rSO_(2)value before,during and after CPB(CPB_(1)rSO_(2lowest),CPB_(2)rSO_(2lowest),CPB_(3)rSO_(2lowest)),the greatest decrease in intraoperative rSO_(2)from the baseline value before,during and after CPB(CPB_(1)rSO_(2decrease),CPB_(2)rSO_(2decrease),CPB_(3)rSO_(2decrease))were recorded.Multivariate logistic regression analysis was used to identify the risk factors for POD,and the receiver operating characteristic(ROC)curve was drawn to evaluate the accuracy of the related risk factors.Results A total of 130 patients were enrolled,with 32 cases in POD group and 98 cases in non-POD group,and the incidence of POD was 24.6%.The results of logistic regression analysis showed that the CPB_(2)rSO_(2decrease),CPB_(2)rSO_(2lowest)and operation time were independent risk factors for POD(P<0.05).The area under the ROC curve(95%confidence interval)of CPB_(2)rSO_(2decrease)>11.2%predicting POD was 0.655(0.533-0.778),sensitivity 68.9%,and specificity 62.9%.The area under the ROC curve(95%confidence interval)of operation time>237.5 min predicting POD was 0.751(0.652-0.849),sensitivity 62.5%,and specificity 78.6%.Conclusions CPB_(2)rSO_(2decrease),CPB_(2)rSO_(2lowest)and operation time are independent risk factors for POD in frail elderly patients undergoing cardiac surgery;both CPB_(2)rSO_(2decrease)and operation time can effectively predict the occurrence of POD in frail elderly patients undergoing cardiac surgery.