2024 年第 5 期 第 0 卷

冠状动脉旁路移植术术后谵妄的危险因素分析及预测模型的建立

Analysis of risk factors for postoperative delirium after coronary artery bypass grafting and establishment of prediction model

作者：胡霄竹 韩晴 屈丽楠 董然 李雪梅

英文作者：Hu Xiaozhu Han Qing Qu Linan Dong Ran Li Xuemei

单位：首都医科大学附属北京安贞医院心脏外科，北京100029

英文单位：Department of Cardiac Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：冠状动脉旁路移植术；谵妄；危险因素；预测模型

英文关键词：Coronaryarterybypassgrafting;Delirium;Riskfactor;Predictivemodel

• 摘要：

• 目的  探讨冠状动脉旁路移植术（CABG）术后谵妄发生的危险因素，并建立风险预测模型。方法  回顾性收集首都医科大学附属北京安贞医院冠心病外科中心2022年1月至2023年6月1 067例行CABG患者的临床资料。采用重症监护病房（ICU）意识模糊评估法（CAM-ICU）评估患者术后谵妄的发生，将患者分为谵妄组和非谵妄组。对比2组患者的临床特征，采用单因素分析和多因素二元Logistic回归分析确定影响谵妄发生的独立危险因素，建立预测谵妄风险的列线图模型，绘制受试者工作特征(ROC)曲线评估谵妄模型的预测价值。结果  1 067例患者中谵妄组133例，谵妄发生率为12.5%，年龄（62±10）岁，男性97例；非谵妄组934例，年龄（62±9）岁，男性704例。使用SPSS 22.0软件随机抽取747例患者作为试验组，剩余320例患者作为内部验证组。多因素Logistic回归分析结果显示，初中以下学历、术前睡眠障碍、糖尿病史、左心室射血分数（LVEF）≤45%、轻度贫血、低蛋白血症、体外循环以及呼吸机使用≥48 h是试验组患者CABG术后发生谵妄的独立危险因素(均P＜0.05)。经ROC验证显示试验组曲线下面积(AUC)为0.736（95%置信区间：0.682～0.739），Hosmer-Lemeshow拟合优度检验显示风险预测模型具有较好拟合度，P=0.748。经内部验证该评分预警系统AUC为0.754（95%置信区间：0.690～0.819），Hosmer-Lemeshow拟合优度检验同样显示该模型预测准确性较好，P=0.808。结论  谵妄是CABG术后常见的并发症之一，低学历、术前睡眠障碍、体外循环及长时间使用呼吸机等都是CABG术后谵妄发生的独立危险因素。

• Objective  To investigate the risk factors of postoperative delirium after coronary artery bypass grafting (CABG) and to establish a risk prediction model. Methods  The clinical data of 1 067 patients who underwent CABG at Coronary Heart Disease Surgery Center, Beijing Anzhen Hospital, Capital Medical University from January 2022 to June 2023 were retrospectively collected. The intensive care unit (ICU) confusion assessment method (CAM-ICU) was used to assess the occurrence of postoperative delirium. The patients were divided into delirium group and non-delirium group. The clinical characteristics of the two groups were compared. Univariate analysis and multivariate binary Logistic regression analysis were used to determine the independent risk factors affecting the occurrence of delirium, and a nomogram model for predicting the risk of delirium was established. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of the delirium model. Results  Among 1 067 patients, there were 133 patients in delirium group, the incidence of delirium was 12.5%, the age was (62±10)years, and 97 cases were male. There were 934 patients in the non-delirium group, the age was (62±9)years and 704 cases were male. SPSS 22.0 software was used to randomly select 747 patients as the experimental group, and the remaining 320 patients were used as the internal validation group. Multivariate Logistic regression analysis showed that education below junior high school, preoperative sleep disorders, history of diabetes mellitus, left ventricular ejection fraction (LVEF) ≤45%, mild anemia, hypoproteinemia, cardiopulmonary bypass and ventilator use ≥48 h were independent risk factors for delirium after CABG in the experimental group (all P＜0.05). The ROC analysis showed that the area under the curve (AUC) of the experimental group was 0.736 (95% confidence interval: 0.682-0.739). The Hosmer-Lemeshow goodness of fit test showed that the risk prediction model had a good goodness of fit, and the P value was 0.748. The AUC of the scoring early warning system was 0.754 (95% confidence interval: 0.690-0.819). The Hosmer-Lemeshow goodness of fit test showed that the risk prediction model had a good goodness of fit, and the P value was 0.808. Conclusion  Delirium is one of the common complications after CABG. Low education level, preoperative sleep disorders, cardiopulmonary bypass and long-term use of ventilator are independent risk factors for delirium after CABG.