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

杨菁; 刘梅; 杨蕾; 顾则娟

doi:10.16766/j.cnki.issn.1674-4152.003691

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

doi: 10.16766/j.cnki.issn.1674-4152.003691

杨菁^{1, 2},
刘梅³,
杨蕾³,
顾则娟^{2, 3, ,}

1.
南京医科大学第一附属医院骨科，江苏南京 210029
2.
南京医科大学护理学院，江苏南京 211100
3.
南京医科大学第一附属医院护理部，江苏南京 210029

基金项目:

江苏省医学创新团队基金资助项目 CXTDA2017019

江苏省科技项目 BK20221415

详细信息

通讯作者:
顾则娟，E-mail：jassicagu@163.com

中图分类号: R683.3
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- 文章访问数: 25
- HTML全文浏览量: 8
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-05-18

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

YANG Jing^{1, 2},
LIU Mei³,
YANG Lei³,
GU Zejuan^{2, 3
, ,}

1.
Orthopedics of the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China

摘要

摘要: 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。
- 髋部骨折 /
- 术后谵妄 /
- 危险因素 /
- 列线图
Abstract: Objective The 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. Methods The 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. Results The 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. Conclusion Older 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.
- Hip fracture /
- Postoperative delirium /
- Risk factors /
- Line chart
利益冲突 无

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图 1 预测老年髋部骨折患者POD发生的列线图模型

Figure 1. Nomogram model for predicting POD in elderly patients with hip fracture

下载: 全尺寸图片幻灯片

图 2 老年髋部骨折患者POD发生的内部验证图

Figure 2. Internal validation diagram of POD in elderly patients with hip fracture

下载: 全尺寸图片幻灯片

图 3 老年髋部骨折患者POD发生的列线图模型内部检验ROC曲线

Figure 3. ROC curve for the internal validation of the nomogram model POD in elderly patients with hip fractures

下载: 全尺寸图片幻灯片

表 1 2组老年髋部骨折患者基线资料比较

Table 1. Comparison of baseline data between the two groups of elderly patients with hip fracture

变量	发生组(n=39)	未发生组(n=98)	统计量	P值
年龄(x±s，岁)	77.38±3.55	74.42±2.59	5.417^a	＜0.001
BMI(x±s)	23.52±1.16	23.67±1.24	0.651^a	0.517
性别[例(%)]			0.038^b	0.845
男性	16(41.03)	42(42.86)
女性	23(58.97)	56(57.14)
文化程度[例(%)]			0.086^c	0.932
小学及以下	12(30.77)	29(29.59)
初中/高中	19(48.72)	49(50.00)
大专及以上	8(20.51)	20(20.41)
婚姻状况[例(%)]			0.037^b	0.848
已婚	2(5.13)	4(4.08)
未婚/离异	37(94.87)	94(95.92)
ASA分级[例(%)]			0.377^c	0.706
Ⅰ级	14(35.90)	37(37.76)
Ⅱ级	21(53.85)	54(55.10)
Ⅲ级	4(10.26)	7(7.14)
麻醉方式[例(%)]			0.040^b	0.842
腰麻	28(71.79)	72(73.47)
全麻	11(28.21)	26(26.53)
手术时间(x±s，min)	77.12±10.45	76.32±10.25	0.407^a	0.685
术前等待时间(x±s，d)	5.43±1.14	3.88±1.13	7.216^a	＜0.001
术前白蛋白(x±s，g/L)	34.51±2.28	37.26±2.14	6.650^a	＜0.001
术前血红蛋白(x±s, g/L)	108.32±15.58	109.36±16.56	0.346^a	0.730
术中出血量(x±s，mL)	209.17±17.43	186.48±18.43	6.767^a	＜0.001
术后低氧血症[例(%)]			19.651^b	＜0.001
有	17(43.59)	10(10.20)
无	22(56.41)	88(89.80)
术后电解质紊乱[例(%)]			0.283^b	0.595
有	10(25.64)	21(21.43)
无	29(74.36)	77(78.57)
糖尿病[例(%)]			21.478^b	＜0.001
有	17(43.59)	9(9.18)
无	22(56.41)	89(90.82)
高血压[例(%)]			0.045^b	0.831
有	12(30.77)	32(32.65)
无	27(69.23)	66(67.35)
冠心病[例(%)]			0.150^b	0.698
有	10(25.64)	24(24.49)
无	29(74.36)	74(75.51)
术前衰弱程度[例(%)]			3.292^c	0.001
无衰弱	17(43.59)	69(70.41)
衰弱前期	12(30.77)	23(23.47)
衰弱	10(25.64)	6(6.12)
术后疼痛评分(x±s，分)	6.13±1.40	4.71±1.24	5.514^a	＜0.001
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 老年髋部骨折患者POD发生的影响因素分析

Table 2. Analysis of factors influencing POD in elderly patients with hip fracture

相关因素	B	SE	Waldχ²	P值	OR值	95% CI
年龄大	0.387	0.194	3.974	0.046	1.473	1.007~2.156
术前等待时间长	1.303	0.575	5.129	0.024	3.680	1.192~11.366
术前白蛋白	-0.727	0.236	9.526	0.002	0.483	0.305~0.767
术中出血量	-0.004	0.034	0.014	0.906	0.996	0.931~1.065
术后低氧血症	2.546	1.142	4.970	0.026	12.750	1.360~119.536
有糖尿病	2.547	1.182	4.645	0.031	12.763	1.260~129.321
衰弱前期	1.026	1.067	0.924	0.336	2.789	0.345~22.561
衰弱	3.868	1.542	6.292	0.012	47.860	2.330~983.173
术后疼痛评分	1.560	0.478	10.632	0.001	4.757	1.863~12.147

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