2025 年第 7 期 第 20 卷

严重多发骨折创伤患者术后发生谵妄的影响因素及其列线图风险预测模型的构建

The influencing factors of postoperative delirium in patients with severe multiple fractures trauma and the construction of its nomogram risk prediction model

作者：元智昊1陈芳顺1李奕鑫1蔡雅婷1刘金花2

英文作者：Yuan Zhihao1 Chen Fangshun1 Li Yixin1 Cai Yating1 Liu Jinhua2

单位：1中国人民解放军联勤保障部队第九一〇医院重症医学科，泉州362000；2中国人民解放军联勤保障部队第九一〇医院麻醉科，泉州362000

英文单位：1Department of Critical Care Medicine the 910th Hospital of Joint Logistics Support Force of the Chinese People′s Liberation Army Quanzhou 362000 China; 2Department of Anesthesiology the 910th Hospital of Joint Logistics Support Force of the Chinese People′s Liberation Army Quanzhou 362000 China

关键词：术后谵妄；严重多发骨折创伤；影响因素；预测模型；列线图

英文关键词：Postoperativedelirium;Severemultiplefracturetrauma;Influencingfactors;Predictionmodel;Nomogram

• 摘要：

• 目的 探讨导致严重多发骨折创伤患者术后谵妄的危险因素，建立并验证列线图模型。方法 选取2019年1月至2022年12月于中国人民解放军联勤保障部队第九一〇医院就诊并行手术治疗的220例严重多发骨折创伤患者为建模集，另选取2023年1—12月94例严重多发骨折创伤患者为验证集。根据是否发生谵妄将建模集患者分为非谵妄组（147例）和谵妄组（73例）。比较非谵妄组和谵妄组患者临床资料。分析导致术后谵妄的危险因素，建立并验证列线图模型的准确度。结果 谵妄组患者年龄、损伤严重程度（ISS）评分、入住重症监护病房（ICU）天数及肢体约束、美国麻醉医师协会（ASA）分级Ⅲ～Ⅳ级、机械通气、麻醉方式全身麻醉的患者比例均明显大于/高于非谵妄组患者，术前白蛋白水平明显低于非谵妄组（均P＜0.05）。多元Logistic回归分析结果表明年龄≥60岁、术前白蛋白≤30 g/L、ASA分级Ⅲ～Ⅳ级、ISS评分≥21分、麻醉方式全身麻醉及入住ICU天数≥9 d均为术后谵妄的独立影响因素（均P＜0.05）。受试者工作特征曲线显示建模集和验证集的曲线下面积分别为0.803（95%置信区间：0.706～0.875）和0.818（95%置信区间：0.678～0.962），显示出较好的预测精准度。列线图风险预测模型的校准曲线显示，建模集和验证集的预测与观测吻合良好，Hosmer-Lemeshow检验的P值分别为0.405和0.669，P值不显著。结论 基于年龄≥60岁、术前白蛋白≤30 g/L、ASA分级Ⅲ～Ⅳ级、ISS评分≥21分、麻醉方式全身麻醉及入住ICU天数≥9 d建立的列线图风险预测模型，对严重多发骨折创伤患者术后发生谵妄预测的准确度良好，可用于指导临床采取必要的预防干预措施。

• Objective  To explore the risk factors of postoperative delirium in patients with severe multiple fracture trauma, and to establish and verify a nomogram model. Methods A total of 220 patients with severe multiple fracture trauma who were treated and operated in the 910th Hospital of Joint Logistics Support Force of the Chinese People′s Liberation Army from January 2019 to December 2022 were selected as the modeling set. Another 94 patients with severe multiple fracture trauma from January to December 2023 were selected as the validation set. According to whether delirium occurred, the patients in the modeling set were divided into non-delirium group (147 cases) and delirium group (73 cases). The clinical data of non-delirium group and delirium group were compared. The risk factors of postoperative delirium were analyzed, and the accuracy of the nomogram model was established and verified. Results The age, injury severity (ISS) score, length of intensive care unit (ICU) stay, the proportions of patients with physical restraint, American Society of Anesthesiologists (ASA) grade Ⅲ-Ⅳ, mechanical ventilation, and general anesthesia were significantly greater/higher in the delirium group than in the non-delirium group, and the preoperative albumin level was significantly lower in the delirium group than in the non-delirium group (all P＜0.05). Multivariate Logistic regression analysis showed that age ≥60 years, preoperative albumin ≤30 g/L, ASA grade Ⅲ-Ⅳ, ISS score ≥21, general anesthesia and ICU stay ≥9 days were independent risk factors for preoperative albumin (all P＜0.05). The receiver operating characteristic curve showed that the area under the curve of the modeling set and the validation set were 0.803 (95% confidence interval: 0.706-0.875) and 0.818 (95% confidence interval: 0.678-0.962), respectively, which showed good prediction accuracy. The calibration curve of the nomogram risk prediction model showed that the predictions of the modeling set and the validation set were in good agreement with the observations. The P values of Hosmer-Lemeshow test were 0.405 and 0.669, respectively, and the P values were not significant. Conclusion The nomogram risk prediction model based on age ≥60 years, preoperative albumin ≤30 g/L, ASA grade Ⅲ-Ⅳ, ISS score ≥21, general anesthesia and ICU stay ≥9 days has good accuracy in predicting postoperative delirium in patients with severe multiple fracture trauma, which can be used to guide clinical preventive intervention measures.