非体外循环冠状动脉搭桥术后谵妄的DynNom预测模型构建

Construction of DynNom prediction model for postoperative delirium after off-pump coronary artery bypass grafting

目的基于DynNom动态评分构建非体外循环冠状动脉搭桥术后谵妄预测模型。方法收集2020年6月至2023年6月于江苏省人民医院行非体外循环冠状动脉搭桥术的265例患者临床资料,根据术后谵妄发生情况将患者分为谵妄组(n=61)和非谵妄组(n=204)。采用单因素和多因素Logistic回归法分析非体外循环冠状动脉搭桥术后谵妄的危险因素,并建立DynNom预测模型。结果非体外循环冠状动脉搭桥术后谵妄的发生率为23.02%(61/265)。两组糖化血红蛋白(HbA1c)、简易智力状态检查量表(MMSE)评分、营养风险筛查2002(NRS2002)评分、左室射血分数(LVEF)、酸碱平衡紊乱和电解质紊乱比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,HbA1c≥7%、MMSE评分<27分、NRS2002评分≥3分、LVEF<50%、酸碱平衡紊乱和电解质紊乱是非体外循环冠状动脉搭桥术后谵妄的独立危险因素(P<0.05)。DynNom预测模型评估结果显示,C-index指数为0.747(95%CI 0.711~0.783),校准曲线贴近理想曲线,受试者工作特征(ROC)曲线下面积(AUC)为0.753(95%CI 0.721~0.785),当DynNom模型预测值在10%~79%范围时,患者的净获益率>0。结论基于HbA1c≥7%、MMSE评分<27分、NRS2002评分≥3分、LVEF<50%、酸碱平衡紊乱和电解质紊乱构建的DynNom预测模型对非体外循环冠状动脉搭桥术后谵妄的发生风险具有一定的预测价值。

Objective To construct a prediction model for postoperative delirium after off-pump coronary artery bypass grafting based on the DynNom dynamic score.Methods A total of 265 patients underwent off-pump coronary artery bypass grafting in Jiangsu Provincial People's Hospital from June 2020 to June 2023 were selected as study subjects.The clinical data of the patients were collected,and the patients were categorized into delirium group(n=61)and non-delirium group(n=204)according to the occurrence of postoperative delirium.Risk factors for postoperative delirium after off-pump coronary artery bypass grafting were analyzed by using univariate and multivariate Logistic regression analysis,and a DynNom prediction model was developed.Results The incidence of delirium after off-pump coronary artery bypass grafting was 23.02%(61/265).There was a statistically significant difference in glycosylated hemoglobin(HbA1c),mini-mental state examination(MMSE)score,nutritional risk screening(NRS)2002 score,left ventricular ejection fraction(LVEF),acid-base balance disorder,and electrolyte disorder between the two groups(P<0.05).Multivariate Logistic regression analysis showed that HbA1c≥7%,MMSE score<27,NRS2002 score≥3,LVEF<50%,acid-base balance disorder,and electrolyte disorder were independent risk factors for postoperative delirium after off-pump coronary artery bypass grafting(P<0.05).The validation results of the DynNom prediction model showed the C-index was 0.747(95%CI 0.711-0.783),the calibration curve was close to the ideal curve,the area under the receiver operating characteristic(ROC)curve(AUC)was 0.753(95%CI 0.721-0.785),and the net benefit of patients was>0 when the predictive value of the DynNom model was in the range of 10% to 79%.Conclusions The DynNom prediction model constructed based on the HbA1c≥7%,MMSE score<27,NRS2002 score≥3,LVEF<50%,acid-base balance disorder and electrolyte disorder has a certain predictive value in the risk of postoperative delirium after off-pump coronary artery bypass grafting.