小儿纤维支气管镜术后躁动风险及预测模型建立

Risk and prediction model of agitation after fiberbronchoscope in children

目的探讨小儿纤维支气管镜术后躁动风险,并建立预测模型。方法选取2023年9月至2024年2月在本院行纤维支气管镜术的患儿112例为研究对象,统计术后躁动发生情况。根据患儿是否发生术后躁动进行分组,其中发生术后躁动的归入观察组,未发生术后躁动的归入对照组。分析小儿纤维支气管镜术后躁动影响因素,采用R3.5.1软件建立列线图预测模型并进行验证。结果112例患儿中34例(30.36%)发生术后躁动,归入观察组,其余78例归入对照组。34例患儿术后多发生1次(41.18%)或2次(47.06%)躁动,小儿麻醉苏醒期躁动量化评分表(PAED)评分多为16~18分,其中17分最多(35.29%)。观察组静脉麻醉+吸入麻醉、术后疼痛比例、麻醉时间大于对照组,年龄、脑电双频指数50~59比例小于对照组(P<0.05)。年龄、脑电双频指数为50~59是小儿纤维支气管镜术后躁动独立保护因素,麻醉方式为静脉麻醉+吸入麻醉、麻醉时间、术后疼痛是其独立危险因素(P<0.05)。建立Logistic回归方程:logit(P)=-4.861-1.163×年龄+1.522×麻醉方式+0.132×麻醉时间+1.703×术后疼痛-1.779×脑电双频指数。列线图模型的C-index为0.881,预测小儿纤维支气管镜术后躁动的ROC曲线下面积为0.881(95%CI:0.806~0.935),敏感度为85.29%,特异性为78.21%,约登指数为0.635。校准曲线斜率结果显示Brier得分为0.086,校准斜率为0.894。结论小儿纤维支气管镜术后躁动发生风险较高,其影响因素包括年龄、麻醉方式、麻醉时间、术后疼痛、脑电双频指数,据此构建的预测模型具有较高的预测效能。

Objective:To investigate the risk of agitation after fiberbronchoscope in children and establish a prediction model.Methods:A total of 112 children who underwent fiberbronchoscopy in the hospital from September 2023 to February 2024 were selected as study objects,and the incidence of postoperative agitation was analyzed.The children with postoperative agitation were classified into observation group and those without postoperative agitation were classified into control group.The influencing factors of agitation after fiberbronchoscope in children were analyzed,and the nomogram prediction model was established and verified by R3.5.1 software.Results:Among the 112 children,34(30.36%)had postoperative agitation,which was assigned to the observation group,and the other 78 cases were assigned to the control group.The 34 patients had 1(41.18%)or 2(47.06%)more agitation after surgery,and the PAED score was mostly 16~18,with 17(35.29%)being the most frequent.The proportion of intravenous anesthesia+inhalation anesthesia,postoperative pain and anesthesiatime in the observation group were higher than those in the control group,and the proportion of age and bifrequency index 50~59 in the observation group were lower than those in the control group(P<0.05).Age≥6 years old,EEG bifrequency index of 50~59 were independent protective factors for agitation after fiberbronchoscope in children.Anesthesia method was intravenous anesthesia+inhalation anesthesia,anesthesia time and postoperative pain were independent risk factors(P<0.05).Logistic regression equation was established:logit(P)=-4.861-1.163×age+1.522×anesthesia method+0.132×anesthesia time+1.703×postoperative pain-1.779×EEG bifrequency index.The C-index of the nomogram model was 0.881,and the area under the ROC curve was 0.881(95%CI:0.806~0.935),the sensitivity was 85.29%,the specificity was 78.21%,and the Yoden index was 0.635.The calibration curve slope results showed that the Brier score was 0.086 and the calibration slope was 0.894.Conclusion:The risk of agitation after fiberbronchoscope in children is higher,and the influencing factors include age,anesthesia method,anesthesia time,postoperative pain and EEG dual frequency index.The prediction model based on this model has high efficacy.