术前股四头肌超声定量分析预测胃肠手术老年患者术后谵妄的价值

Value of preoperative quantitative quadriceps muscle ultrasound measures in predicting postoperative delirium in elderly patients undergoing gastrointestinal surgery

目的评价术前股四头肌超声定量分析预测胃肠手术老年患者术后谵妄(POD)的价值。方法本研究为前瞻性研究。选择2023年3月至12月江苏省苏北人民医院择期全身麻醉下行胃肠外科手术老年患者277例,年龄65~88岁,性别不限,ASA分级≤Ⅳ级,BMI≤30 kg/m^(2)。于麻醉诱导前超声测量股四头肌厚度及回声强度。术后1~7 d时采用意识模糊评估法(CAM)评估谵妄发生情况。根据患者是否发生POD分为POD组和非POD组。将组间比较差异有统计学意义的因素纳入logistic回归分析,筛选POD发生的独立危险因素,并依此构建胃肠外科手术老年患者POD的列线图预测模型。绘制受试者工作特征曲线,采用曲线下面积(AUC)评价各独立危险因素及列线图预测模型对POD的预测价值,结合Youden指数确定预测POD的临界值,并计算灵敏度和特异度。结果logistic回归分析显示,年龄、术前简易精神状态检查量表评分、股四头肌厚度和股四头肌回声强度是胃肠外科手术老年患者POD发生的独立危险因素(P<0.05)。术前股四头肌厚度的AUC为0.695(95%置信区间0.614~0.746),临界值为2.465 cm,灵敏度为73.7%,特异度为78.2%;术前股四头肌回声强度的AUC为0.717(95%置信区间0.662~0.773),临界值为59.985,灵敏度为81.9%,特异度为48.5%。结论术前超声测量股四头肌厚度及回声强度是胃肠外科手术老年患者POD发生的独立危险因素,对POD具有一定的预测价值。

Objective To evaluate the value of preoperative quantitative quadriceps muscle ultrasound measures in predicting postoperative delirium(POD)in elderly patients undergoing gastrointestinal surgery.Methods This was a prospective study.A total of 277 elderly patients of both sexes,aged 65-88 yr,with American Society of Anesthesiologists Physical Status classification≤Ⅳand body mass index of≤30 kg/m^(2),undergoing elective gastrointestinal surgery with general anesthesia at the Northern Jiangsu People′s Hospital from March to December 2023,were included in the study.The quadriceps femoris thickness and echo intensity were measured using ultrasound before induction of anesthesia.Delirium was assessed using the Confusion Assessment Method score at 1-7 days after operation.The patients were divided into 2 groups based on the occurrence of POD:POD group and non-POD group.Factors with statistically significant differences between groups were included in the logistic regression analysis to identify the independent risk factors for POD,and then a visual risk Nomogram prediction model for POD risk factors was developed based on this analysis in elderly patients undergoing gastrointestinal surgery.The receiver operating characteristic curve was plotted,and the area under the receiver operating characteristic curve(AUC)and 95%confidence interval(CI)were used to evaluate the predictive value of each independent risk factor and Nomogram prediction model for POD.The Youden Index was used to determine the critical value for predicting POD,and the sensitivity and specificity were calculated.Results The results of logistic regression analysis revealed that age,preoperative Mini-Mental State Examination scores,quadriceps femoris thickness and echo intensity of quadriceps femoris were independent risk factors for POD in elderly patients undergoing gastrointestinal surgery(P<0.05).The AUC of preoperative quadriceps femoris thickness was 0.695(95%CI 0.614-0.746),the critical value 2.465 cm,the sensitivity 73.7%and the specificity 78.2%.The AUC of preoperative quadriceps femoris echo intensity was 0.717(95%CI 0.662-0.773),the critical value 59.985,the sensitivity 81.9%and the specificity 48.5%.Conclusions Preoperative ultrasound measurement of quadriceps femoris thickness and echo intensity is an independent risk factor for POD and has some predictive value for POD in elderly patients undergoing gastrointestinal surgery.