PROPDESC和MDP谵妄风险预测模型在老年手术患者中的应用研究

Application of PROPDESC and MDP delirium risk prediction models in elderly surgical patients

目的将基于术前筛查的术后谵妄预测模型(PROPDESC)和梅奥谵妄预测模型(MDP)用于探讨老年患者术后谵妄的独立预测因素,并分析2个模型的预测能力。方法本研究为前瞻性队列研究。采用便利抽样法,选取2022年5—8月汕头市中心医院骨科、胃肠外科、心胸外科、肿瘤外科收治的636例老年手术患者为研究对象,使用PROPDESC和MDP预测老年手术患者术后谵妄发生情况。比较2个预测模型的受试者工作特征曲线下面积(AUC)和诊断特征,并对2个模型中的19个预测因素进行单因素分析和Logistic回归分析,确定术后谵妄发生的独立影响因素。结果 PROPDESC和MDP外部验证的AUC分别为0.87(95%CI:0.84~0.90)和0.89(95%CI:0.86~0.92),敏感性分别为71.79%和80.34%,特异性分别为85.16%和81.12%。Logistic回归分析发现,急诊入院、年龄、蒙特利尔短期认知评估中的句子重复和序列减法是术后谵妄的独立影响因素(P<0.05)。结论 PROPDESC和MDP预测模型对老年手术患者术后谵妄的预测能力尚可,可在此基础上构建适用于我国不同外科老年人群的谵妄风险评估工具。

Objective To explore independent predictors of postoperative delirium in elderly patients by PRe-Operative Prediction of postoperative DElirium by appropriate SCreening(PROPDESC)and Mayo Delirium Prediction(MDP),and analyze the predictive power of the two models.Methods This study was a prospective Cohort study.Using the convenient sampling method,a total of 636 elderly surgical patients admitted to the Orthopedics,Gastroenterology,Cardiothoracic and Oncology Departments of Shantou Central Hospital from May to August 2022 were selected as the research objects.PROPDESC and MDP were used to predict postoperative delirium in elderly patients.The area under the receiver operating characteristic(AUC)and diagnostic characteristics of the two predictive models were compared,and the single factor analysis and Logistic regression analysis were performed on 19 predictive factors of the two models to determine the independent influencing factors of postoperative delirium.Results The AUC for external verification of the PROPDESC and MDP were 0.87(95%CI:0.84-0.90)and 0.89(95%CI:0.86-0.92),respectively.The sensitivity of 71.79%and 80.34%,and specificity of 85.16%and 81.12%,respectively.Logistic regression analysis showed that emergency admission,age,sentence repetition and sequence subtraction in Montreal Cognitive Assessment(MoCA)were independent influencing factors for postoperative delirium(P<0.05).Conclusions The predictive ability of PROPDESC and MDP models to predict postoperative delirium in elderly patients is satisfactory.On this basis,delirium risk assessment tools suitable for different surgical elderly populations in China can be constructed.