摘要
目的 构建老年肺癌根治切除术后谵妄(POD)风险模型并评估其效能。方法 选择新疆医科大学附属肿瘤医院重症医学科2022年3月至8月收治的618例老年肺癌根治术患者作为研究对象,采用简单随机抽样法,按照7∶3的比例将患者分为训练集(n=433)与验证集(n=185)。术后1~3 d,由具有资历的工作人员采用意识模糊评估法评估患者POD发生情况,收集患者一般人口学资料,术前、术中及术后各指标资料。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ^(2)检验进行组间比较。采用二元logistic回归模型筛查影响训练集患者POD发生的相关因素,并构建POD预测模型,绘制受试者工作特征(ROC)曲线,利用验证集对预测模型的效能进行验证。结果 618例老年肺癌患者根治术后共119例并发POD(19.26%),其中训练集88例(20.32%),验证集31例(16.76%),两组患者POD发生率比较,差异无统计学意义(χ^(2)=1.061,P=0.303)。以训练集患者是否发生POD作为因变量,行二元logistic回归分析,结果提示年龄>79岁(OR=2.221,95%CI 1.642~3.004)、查尔森合并症指数(CCI)评分≥2分(OR=1.540,95%CI 1.011~2.348)、开胸手术(OR=1.902,95%CI 1.177~3.075)及丙泊酚用量(OR=1.413,95%CI 1.133~1.764)是老年肺癌根治术患者发生POD的独立影响因素。ROC曲线提示,上述结果构建的预测模型在预测验证集患者POD发生风险中的曲线下面积(AUC)为0.832(95%CI 0.746~0.917),灵敏度及特异度分别为0.710、0.838。结论 年龄、CCI评分、手术方式及丙泊酚用量是影响老年肺癌患者根治术后POD发生的独立危险因素,基于此构建的风险预测模型在预测患者POD中具有良好的应用效能,但为保障结论的可靠性,还需增加研究样本进行外部验证。
Objective To construct a risk model of postoperative delirium(POD)after radical resection of lung cancer in elderly patients and evaluate its efficiency.Methods A total of 618 elderly patients with radical resection of lung cancer in the Department of Intensive Care Medicine of the Tumor Hospital Affiliated to Xinjiang Medical University were selected from March 2022 to August 2022 as the research subjects.The patients were divided into a training set(n=433)and a validation set(n=185)in a 7∶3 ratio using simple random sampling.At 1-3 days after surgery,the occurrence of POD was evaluated by the qualified staff using confusion assessment method.General demographic data,preoperative,intraoperative and postoperative indicators were collected.SPSS 26.0 was used for data processing.According to the data type,t test or Chi-square test was performed.Factors affecting the occurrence of POD in the training set were screened by binary logistic regression model.A POD prediction model was constructed,and receiver operating characteristic(ROC)curve was drawn.The validation set was used to verify the efficiency of the prediction model.Results Of 618 elderly patients with lung cancer,119(19.26%)developed POD,with 88(20.32%)in the training set and 31(16.76%)in the validation set,and there was no statistically significant difference between the two groups(χ^(2)=1.061,P=0.303).With presence or absence of POD in the training group as the dependent variable,binary logistic regression analysis indicated that age>79 years(OR=2.221,95%CI 1.642-3.004),Charlson comorbidity index(CCI)score≥2 points(OR=1.540,95%CI 1.011-2.348),thoracotomy(OR=1.902,95%CI 1.177-3.075),and propofol dosage(OR=1.413,95%CI 1.133-1.764)were independent influencing factors of POD occurrence in elderly patients undergoing radical resection of lung cancer.ROC curve showed an area under the curve(AUC)of 0.832(95%CI 0.746-0.917)for the prediction model constructed on the above results in predicting POD risk in the validation set,with a sensitivity of 0.710 and a specificity of 0.838.Conclusion Age,CCI score,surgical method and propofol dosage are independent risk factors for POD in elderly patients after radical resection of lung cancer.The risk prediction model based on these factors demonstrates good performance in predicting POD in patients.In order to ensure the reliability of the conclusion,external verification is necessary with increased samples.
作者
张云飞
许华
单世君
夏源
张秀华
Zhang Yunfei;Xu Hua;Shan Shijun;Xia Yuan;Zhang Xiuhua(School of Nursing,Xinjiang Medical University,Urumqi 830011,China;Department of Intensive Care Medicine,Tumor Hospital Affiliated to Xinjiang Medical University,Urumqi 830011,China)
出处
《中华老年多器官疾病杂志》
2025年第6期411-416,共6页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
国家自然科学基金(81060097)。
关键词
肺癌
根治术
术后谵妄
预测模型
lung cancer
radical resection
postoperative delirium
prediction model
作者简介
通信作者:张秀华,E-mail:1464531374@qq.com。
