中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (33): 5340-5345.doi: 10.12307/2024.656

• 人工假体 artificial prosthesis • 上一篇    下一篇

老年全膝关节置换后谵妄的危险因素分析及nomogram预测模型建立

林  鹰,廖  琪,严来秀,赖建鸿   

  1. 江西中医药大学附属赣州市中医院,江西省赣州市   341000
  • 收稿日期:2023-03-29 接受日期:2023-09-22 出版日期:2024-11-28 发布日期:2024-01-30
  • 通讯作者: 赖建鸿,副主任医师,江西中医药大学附属赣州市中医院,江西省赣州市 341000
  • 作者简介:林鹰,女,1978年生,2007年赣南医学院毕业,副主任医师,主要从事临床麻醉方面的研究。
  • 基金资助:
    江西省卫生健康委科技计划(202140797),项目负责人:林鹰

Risk factors of delirium after total knee arthroplasty in elderly patients and establishment of nomogram prediction model

Lin Ying, Liao Qi, Yan Laixiu, Lai Jianhong   

  1. Ganzhou Hospital of Traditional Chinese Medicine, Jiangxi University of Chinese Medicine, Ganzhou 341000, Jiangxi Province, China
  • Received:2023-03-29 Accepted:2023-09-22 Online:2024-11-28 Published:2024-01-30
  • Contact: Lai Jianhong, Associate chief physician, Ganzhou Hospital of Traditional Chinese Medicine, Jiangxi University of Chinese Medicine, Ganzhou 341000, Jiangxi Province, China
  • About author:Lin Ying, Associate chief physician, Ganzhou Hospital of Traditional Chinese Medicine, Jiangxi University of Chinese Medicine, Ganzhou 341000, Jiangxi Province, China
  • Supported by:
    Jiangxi Provincial Health Commission Science and Technology Plan, No. 202140797 (to LY)

摘要:


文题释义:

谵妄:是一种急性的有突出认知损害的意识障碍,其主要表现为意识模糊、思维混乱以及注意缺损等,多由疾病因素导致,如各种感染、神经系统疾病,其他因素如中毒和机械压迫等因素引起神经细胞或轴索损害也可产生,一般昼轻夜重。
全膝关节置换:也称作全髁置换,是用生物相容性与机械性能良好的人工材料替换被疾病或损伤所破坏的关节面,重建患者膝关节的正常功能的手术。


背景:术后谵妄是全膝关节置换术后严重并发症之一,通常发生在术后1-5 d,以意识混乱、认知障碍等为主要表现,不利于老年患者术后关节功能恢复。目前针对影响老年全膝关节置换术后谵妄的危险因素尚不明确,亦缺乏将其直观呈现以便推广应用的临床预测研究。

目的:探究老年患者全膝关节置换术后谵妄的危险因素,并建立列线图(nomogram)预测模型。
方法:回顾性分析2019年1月至2021年12月在江西中医药大学附属赣州市中医院诊治的116例接受全膝关节置换老年患者的病历资料,其中29例术后发生谵妄的患者作为观察组,余下87例术后未发生谵妄的患者作为对照组。比较两组患者术前一般临床资料、实验室检查结果以及手术资料,多因素Logistic回归分析影响老年患者全膝关节置换术后谵妄的危险因素,采用受试者工作特征曲线分析独立危险因素并获得最佳截断值,通过R软件构建nomogram模型。

结果与结论:①两组患者年龄、脑血管意外病史、术前住院时间、术前白蛋白、血红蛋白、美国麻醉医师协会分级、手术时间、麻醉时间以及术中输血量比较差异有显著性意义(P < 0.05);②由多因素Logistic回归分析可知,高龄、术前住院时间长、高美国麻醉医师协会分级以及手术时间过长是老年膝关节置换患者术后发生谵妄的危险因素,高白蛋白以及高血红蛋白是老年膝关节置换患者术后发生谵妄的保护因素;③年龄、术前住院时间、白蛋白、血红蛋白、美国麻醉医师协会分级、手术时间的曲线下面积分别为0.784,0.706,0.853,0.762,0.617,0.542,最佳截断值分别为75岁、7 d、40 g/L、125 g/L、3、200 min;④采用内部数据进行验证,一致性指数为0.974,该模型的实际曲线与理想曲线的吻合度较好;⑤提示基于高龄、术前住院时间长、高美国麻醉医师协会分级、低白蛋白、低血红蛋白以及手术时间过长所构建的nomogram模型对老年患者全膝关节置换术后谵妄发生风险的早期识别、预警与诊断有着深远的临床意义。

https://orcid.org/0009-0003-0968-4269 (林鹰) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 老年患者, 全膝关节置换, 术后谵妄, 列线图, 预测模型

Abstract: BACKGROUND: Postoperative delirium is one of the serious complications after total knee arthroplasty, usually occurring 1-5 days after surgery, with confusion and cognitive impairment as the main manifestations, which is not conducive to the recovery of joint function in elderly patients. At present, the risk factors affecting delirium after total knee arthroplasty in the elderly are not clear, and there is a lack of clinical prediction studies to directly present them for promotion and application.
OBJECTIVE: To explore the risk factors of delirium after total knee arthroplasty in elderly patients and establish a prediction model of nomogram. 
METHODS: Medical record data of 116 elderly patients receiving total knee arthroplasty treated in Ganzhou Hospital of Traditional Chinese Medicine, Jiangxi University of Chinese Medicine from January 2019 to December 2021 were retrospectively analyzed, of which 29 elderly patients with delirium after total knee arthroplasty were selected as the observation group, and the remaining 87 elderly patients without delirium after total knee arthroplasty were selected as the control group. Preoperative general clinical data, laboratory examination results, and surgical data were compared between the two groups. Multivariate Logistic regression analysis was used to analyze risk factors for delirium after total knee arthroplasty in elderly patients. The receiver operating characteristic curve was used to analyze the independent risk factors and obtain the best cut-off value. The nomogram model was constructed by R software. 
RESULTS AND CONCLUSION: (1) There were significant differences in age, cerebrovascular accident history, preoperative hospital stay, preoperative albumin, hemoglobin, American Society of Anesthesiologists classification, operation time, anesthesia time, and intraoperative blood transfusion volume between the two groups (P < 0.05). (2) Multivariate Logistic regression analysis showed that old age, long hospital stay before surgery, high American Society of Anesthesiologists classification grade, and long operation time were risk factors for postoperative delirium in elderly knee arthroplasty patients, while high albumin and high hemoglobin were protective factors for postoperative delirium in elderly knee arthroplasty patients. (3) The areas under the curve of age, preoperative hospital stay, albumin, hemoglobin, American Society of Anesthesiologists classification grade, and operation time were 0.784, 0.706, 0.853, 0.762, 0.617, and 0.542, respectively. The optimal cut-off values were 75 years, 7 days, 40 g/L, 125 g/L, 3 and 200 minutes, respectively. (4) After internal data for verification, the consistency index was 0.974. The actual curve of the model was in good agreement with the ideal curve. (5) These results indicate that this nomogram model based on old age, long hospital stay, high American Society of Anesthesiologists classification grade, low albumin, low hemoglobin, and long operation time has far-reaching clinical significance for early identification, early warning and diagnosis of delirium risk in elderly patients after total knee arthroplasty.

Key words: elderly patient, total knee arthroplasty, postoperative delirium, nomogram, prediction model

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