冠脉搭桥术后急性应激障碍危险因素分析及风险预测模型的构建

Analysis of risk factors for acute stress disorder in patients after coronary artery bypass grafting and construction of a risk prediction model

目的:探究冠脉搭桥术后急性应激障碍(ASD)的危险因素并构建风险预测模型。方法:收集2022年5月至2023年5月在郑州大学第一附属医院行冠脉搭桥术的患者320例,根据术后1周内ASD发生情况分为ASD组(n=116)和非ASD组(n=204)。比较两组一般资料,采用Logistic回归模型分析ASD的危险因素,构建列线图模型并评价模型对ASD的预测性能。结果:Logistic回归分析显示,年龄≥45岁,文化程度文盲与小学、初中、高中与中专,性格内向,术前重度胸痛与心功能分级Ⅲ-Ⅳ级是ASD发生的危险因素[OR(95%CI)分别为1.678(1.028~2.739)、2.399(1.187~4.848)、2.994(1.442~6.218)、2.842(1.460~5.531)、3.037(1.591~5.800)、2.254(1.219~4.168)、4.200(2.537~6.953),P<0.05]。列线图模型预测冠脉搭桥术后ASD的ROC曲线的AUC(95%CI)为0.698(0.638~0.758),提示模型预测冠脉搭桥术后ASD的准确性较好。结论:年龄≥45岁,文化程度文盲与小学、初中、高中与中专,性格内向,术前重度胸痛与心功能分级Ⅲ-Ⅳ级是ASD发生的危险因素;基于上述因素建立的风险预测模型具有较好的预测性能。

Aim:To explore the risk factors for acute stress disorder(ASD)in patients after coronary artery bypass grafting and construct a ASD risk prediction model.Methods:Clinical data of 320 patients who underwent coronary artery bypass grafting in the First Affiliated Hospital of Zhengzhou University from May 2022 to May 2023 were collected,and the patients were classified into ASD group(n=116),and non-ASD group(n=204)according to the incidence of ASD within 1 week after the surgery.The general data of the 2 groups were compared.Logistic regression model was used to analyze the influencing factors of ASD after the surgery.Nomogram model predicting ASD was constructed,and the efficiency of the model was assessed.Results:Logistic regression analysis showed that age≥45 years,education level being illiterate and primary school,junior middle school,high school and secondary school,personality being introverted,preoperative severe chest pain and cardiac function classification ofⅢ-Ⅳwere risk factors for the development of ASD[OR(95%CI)was 1.678(1.028-2.739),2.399(1.187-4.848),2.994(1.442-6.218),2.842(1.460-5.531),3.037(1.591-5.800),2.254(1.219-4.168),4.200(2.537-6.953),P<0.05].The AUC(95%CI)of ROC of nomogram model predicting ASD was 0.698(0.638-0.758),suggesting that the model had good efficiency in predicting ASD after the surgery.Conclusion:Age≥45 years,education level being illiterate and primary school,junior middle school,high school and secondary school,personality being introverted,preoperative severe chest pain and cardiac function classification ofⅢ-Ⅳare risk factors for the occurrence of ASD after coronary artery bypass grafting.The nomogram model based on the above risk factors has good efficiency in predicting ASD.