[1]陈璐,谢新芳,孔骞,等.老年上腹部手术患者术后谵妄风险预测模型的构建及验证[J].军事护理,2022,39(06):5-8.[doi:10.3969/j.issn.1008-9993.2022.06.002]
　CHEN Lu,XIE Xinfang,KONG Qian,et al.Development and Verification of a Risk Prediction Model for Postoperative Delirium in Elderly Patients Undergoing Upper Abdominal Surgery...[J].Nursing Journal Of Chinese People's Laberation Army,2022,39(06):5-8.[doi:10.3969/j.issn.1008-9993.2022.06.002]
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老年上腹部手术患者术后谵妄风险预测模型的构建及验证
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《军事护理》[ISSN:2097-1826/CN:31-3186/R]

卷:
39
期数:
2022年06期
页码:
5-8
栏目:
老年健康管理研究专栏
出版日期:
2022-06-15

文章信息/Info

Title:
Development and Verification of a Risk Prediction Model for Postoperative Delirium in Elderly Patients Undergoing Upper Abdominal Surgery...
文章编号:
1008-9993(2022)06-0005-04
作者:
陈璐1; 谢新芳2; 孔骞3; 谢平1; 单汉民1; 沈小英1; 丁秋平1
(1.湖州市中心医院 普外科,浙江 湖州 313000; 2.湖州市中心医院 护理部; 3.石家庄市人民医院 重症医学科,河北 石家庄 050000)
Author(s):
CHEN Lu1; XIE Xinfang2; KONG Qian3; XIE Ping1; SHAN Hanmin1; SHEN Xiaoying1; DING Qiuping1
(1.General Surgery Department,Huzhou Central Hospital,Huzhou 313000,Zhejiang Province,China; 2.Nursing Department,Huzhou Central Hospital; 3.Intensive Care Unit,Shijiazhuang People's Hospital,Shijiazhuang 050000,Hebei Province,China)
关键词:
老年患者;  上腹部手术;  术后谵妄;  风险预测模型
Keywords:
elderly patients;  upper abdominal operation;  postoperative delirium;  risk prediction model
分类号:
R473.6
DOI:
10.3969/j.issn.1008-9993.2022.06.002
文献标志码:
A
摘要:
目的 构建老年上腹部手术患者术后谵妄(postoperative delirium,POD)风险预测模型,并验证其预测效果,以期为早期识别POD发生风险提供依据。方法 2019年9月至2020年6月,选取某三级甲等医院接受上腹部手术的252例老年患者病例资料,比较谵妄组和非谵妄组的各项指标,探索独立危险因素,建立预测模型。用受试者工作特征曲线(receiver operating characteristic curve,ROC)检验模型的预测效果。选取126例同类患者进行模型预测效果验证。结果 谵妄组和非谵妄组患者在年龄、APACHEⅡ评分、高血压、心脏疾病、脑血管意外、手术时限分类、手术等级、睡眠紊乱、术后高热≥38.5℃、术后环境、术后机械通气、术后镇痛药、身体被动约束等方面的差异均有统计学意义(均P<0.05)。年龄、心脏疾病、手术时限分类、睡眠紊乱、术后环境是老年患者上腹部手术后谵妄的独立危险因素。ROC曲线下面积0.665,约登指数0.309,灵敏度0.388,特异度0.921。模型验证准确率为90.5%。结论 构建的预测模型能较好地预测老年患者上腹部手术后谵妄的发生风险,值得在临床推广。
Abstract:
Objective To construct and evaluate the effect of a risk prediction model for postoperative delirium(POD)in elderly patients undergoing upper abdominal surgery,and to provide a basis for early identification of the POD occurrence.Methods A total of 252 elderly patients underwent upper abdominal surgery in a tertiary A hospital from September 2019 to June 2020 were selected,and indicators of the delirium group and the non-delirium group were compared.Independent risk factors were explored for the establishment of the predictive model.The receiver operating characteristic curve(ROC)was used to test the prediction effects of the model.126 patients of the same type were selected to evaluate the model's effects.Results There were statistically significant differences between delirium group and non-delirium group in age,APACHE Ⅱ score,hypertension,heart disease,cerebrovascular accident,operation duration classification,operation grade,sleep disorder,postoperative high fever ≥38.5℃,postoperative environment,postoperative mechanical ventilation,postoperative analgesics,body passive restraint,etc.(all P<0.05).Age,heart disease,duration classification,sleep disturbance and postoperative environment were independent risk factors for delirium after upper abdominal surgery in elderly patients.The area under ROC curve was 0.665,with youden index 0.309,sensitivity 0.388 and specificity 0.921.The model validation accuracy was 90.5%.Conclusions The predictive model can better predict the risk of delirium in elderly patients after upper abdominal surgery,and it is worth promoting in clinic.

参考文献/References:

[1] OH E S,FONG T G,HSHIEH T T,et al.Delirium in older persons:advances in diagnosis and treatment[J].JAMA,2017,318(12):1161-1174.
[2] 中华医学会老年医学分会.老年患者术后谵妄防治中国专家共识[J].中华老年医学杂志,2016,35(12):1257-1262.
[3] 杨丽,李敏,熊蓉,李亚男,等.我国老年病人术后谵妄危险因素的Meta分析[J].循证护理,2018,4(7):584-596.
[4] ALDECOA C,BETTELLI G,BILOTTA F,et al.European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium[J].Eur J Anaesthesiol,2017,34(4):192-214.
[5] JANSSEN T L,STEYERBERG E W,LANGENBERG J C M,et al.Multimodal prehabilitation to reduce the incidence of delirium and other adverse events in elderly patients undergoing elective major abdominal surgery:an uncontrolled before-and-after study[J/OL].[2021-09-08].https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0218152.DOI:10.1371/journal.pone.0218152.
[6] MIYAGAWA Y,YOKOYAMA Y,FUKUZAWA S,et al.Risk factors for postoperative delirium in abdominal surgery:a proposal of a postoperative delirium risk score in abdominal surgery[J].Dig Surg,2017,34(2):95-102.
[7] 孔骞.老年腹部手术患者术后谵妄的危险因素分析及预测模型的构建[D].湖州:湖州师范学院,2020.
[8] CHEN Y,DU H,WEI B H,et al.Development and validation of risk-stratification delirium prediction model for critically ill patients:a prospective,observational,single-center study[J/OL].[2021-09-08].https://journals.lww.com/md-journal/Fulltext/2017/07210/Development_and_validation_of_risk_stratification.38.aspx.DOI:10.1097/MD.0000000000007543.
[9] 邢焕民,吕冬梅,王晓慧,等.术后谵妄风险预测模型的构建及应用[J].中华护理杂志,2019,54(1):8-13.
[10]INOUYE S K,VAN DYCK C H,ALESSI C A,et al.Clarifying confusion:the confusion assessment method.A new method for detectionof delirium[J].Ann Intern Med,1990,113(12):941-948.
[11]周建雄,胥明哲,王蕊,等.老年患者术后谵妄的研究进展[J].临床麻醉学杂志,2019,35(9):920-924.
[12]李乐之,路潜.外科护理学[M].第6版.北京:人民卫生出版社,2017:103-104.
[13]American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults.Postoperative delirium in older adults:best practice statement from the American Geriatrics Society[J].J Am Coll Surg,2015,220(2):136-148,e1.
[14]JANSSEN T L,STEYERBERG E W,FAES M C,et al.Risk factors for postoperative delirium after elective major abdominal surgery in elderly patients:a cohort study[J].Int J Surg,2019(71):29-35.
[15]王春杰,邱颐.术后谵妄发病机制的研究进展[J].承德医学院学报,2018,35(6):512-515.
[16]程晓雪,刘春兰,石萍.急诊腹部手术后患者发生谵妄的相关因素分析及护理对策[J].齐鲁护理杂志,2021,27(2):12-15.
[17]CORTESE G P,BURGER C.Neuro inflammatory challenges compromise neuronal function in the aging brain:postoperative cognitive delirium and Alzheimer's disease[J].Behav Brain Res,2017,322(Pt B):269-279.
[18]郭亮,林飞,于美刚,等.术前睡眠质量对老年患者术后谵妄发生的影响[J].临床麻醉学杂志,2018,34(7):673-677.
[19]陈静,付文广,刘莉,等.老年开腹手术患者术后谵妄的影响因素研究[J].医学信息,2020,33(16):68-71.
[20]祝利花,周敏.心脏术后重症监护室患者的环境压力源分析及其对谵妄的影响[J].2019,36(12):29-31,36.
[21]祝晓迎,刘蕾,何海燕,等.国内外ICU谵妄预防管理现状及对我国的启示[J].护理管理杂志,2017,17(4):260-263.

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备注/Memo

备注/Memo:
【 收稿日期 】 2021-10-12 【 修回日期 】 2022-05-04
【 基金项目 】 浙江省医药卫生科技计划项目(2020KY305)
【 作者简介 】 陈璐,硕士,主管护师,从事外科护理工作
【 通信作者 】 谢新芳,电话:0572-2555887
更新日期/Last Update: 2022-06-15