老年髋部骨折患者术后谵妄发生的危险因素及预测模型构建

Risk factors and predictive model construction of postoperative delirium in elderly patients with hip fracture

目的老年髋部骨折主要的治疗方式为手术,而术后常出现术后谵妄(postoperative delirium,POD),增加患者病死率风险。因此本研究主要探讨POD发生的危险因素并建立预测模型,采取针对性的干预措施减少POD的发生,提高患者生活质量。方法选取2022年6月—2023年12月南京医科大学第一附属医院收治的137例髋部骨折患者资料。根据患者POD诊断结果分为发生组(39例)和未发生组(98例)。比较2组基线资料;采用logistic回归分析研究老年髋部骨折患者POD的危险因素并构建列线图模型;绘制受试者工作特征(receiver operating characteristic curve,ROC)曲线检验列线图模型对POD的预测价值。结果发生组患者年龄、术前等待时间、术中出血量、术后疼痛评分高于未发生组,术前白蛋白低于未发生组,术后低氧血症、糖尿病、术前衰弱患者占比高于未发生组(P<0.05);logistic回归分析显示,年龄大、术前等待时间长、术后低氧血症、有糖尿病、术前衰弱、术后疼痛评分高是POD发生的危险因素(OR>1,P<0.05);术前白蛋白高是POD发生的保护因素(OR<1,P<0.05);结果显示C-index值为0.972;绘制ROC结果显示AUC为0.986(95%CI:0.970~1.000,P<0.05),特异度、敏感度、约登指数分别为0.959、0.949、0.908。结论老年髋部骨折患者年龄大、术前等待时间长、术后低氧血症、糖尿病、术前衰弱、术后疼痛评分高、术前白蛋白水平低是POD发生的危险因素,基于此构建列线图模型对预测POD发生有一定的价值。

ObjectiveThe main treatment of hip fracture in the elderly is surgery,and postoperative delirium(POD)often occurs after surgery,increasing the risk of mortality.Therefore,this study mainly discusses the risk factors of POD and establishes a prediction model to take targeted interventions to reduce the occurrence of POD and improve the quality of life of patients.MethodsThe data of 137 patients with hip fractures admitted to the First Affiliated Hospital of Nanjing Medical University from June 2022 to December 2023 were selected.According to the diagnosis results of POD,the patients were divided into POD group(39 cases)and non-POD group(98 cases).The baseline data of the two groups were compared.Logistic regression was used to analyze the risk factors of POD in elderly patients with hip fracture and construct a nomogram model.The receiver operating characteristic(ROC)curve was drawn to test the predictive value of the nomogram model for POD.ResultsThe age,preoperative waiting time,intraoperative blood loss and postoperative pain score of patients in the POD group were higher than those in the non-POD group,the preoperative albumin was lower than that in the non-POD group,and the proportion of patients with postoperative hypoxemia,diabetes and preoperative weakness was higher than that in the non-POD group(P<0.05).Logistic regression analysis showed that older age,long preoperative waiting time,postoperative hypoxemia,diabetes,preoperative weakness,and high postoperative pain score were risk factors for POD(OR>1,P<0.05).High preoperative albumin is a protective factor for POD(OR<1, P< 0.05).The results showed that the C-index value was 0.972.The ROC results showed that the AUC was 0.986( 95%CI:0.970-1.000,P<0.05),and the specificity,sensitivity,and Youden index were 0.959,0.949,and 0.908,respectively.ConclusionOlder age,long preoperative waiting time,postoperative hypoxemia,diabetes,preoperative frailty,high postoperative pain score and low preoperative albumin level are risk factors for POD in elderly patients with hip fracture.Based on this,a nomogram model is constructed to predict the occurrence of POD.