| 腹部大手术患者麻醉后恢复室内谵妄的现况和影响因素 |
| 投稿时间：2024-07-25 修订日期：2024-09-09 点此下载全文 |
| 引用本文：刘雪娇,齐良,陈亚兰,李鹏,杜文文.腹部大手术患者麻醉后恢复室内谵妄的现况和影响因素[J].医学研究杂志,2025,54(1):92-96 |
| DOI：
10.11969/j.issn.1673-548X.2025.01.017 |
| 摘要点击次数: 130 |
| 全文下载次数: 88 |
|
| 基金项目:浙江省中医药卫生科技项目(2023ZL086)；浙江省温州市科技局基础性公益科研项目(Y2023970) |
|
| 中文摘要:目的 探讨腹部大手术患者麻醉后恢复室(postanesthesia care unit,PACU)内谵妄的发生率及影响因素,并建立列线图预测模型。方法 选取2022年1月~2023年12月在温州医科大学附属第一医院行腹部大手术,手术时长＞4h,术后常规送至PACU的1851例患者为研究对象,根据护理谵妄筛查量表评分是否≥2分,将患者分为谵妄组和非谵妄组。回顾性收集患者术前、术中可能相关的因素,采用LASSO回归筛选变量后,进行单因素及多因素Logistic回归分析确定独立影响因素,并绘制森林图。通过受试者工作特征曲线下面积、Hosmer-Lemeshow检验评价模型的预测效能。结果 113例(6.1%)患者在PACU内出现谵妄,多因素Logistic回归分析显示,性别、年龄、是否使用氟比洛芬酯、低血压、低体温及高碳酸血症、手术时长是PACU内谵妄发生的独立影响因素(P＜0.05),而长时间手术和使用氟比洛芬酯为保护性因素。以此构建的列线图模型经内部验证,AUC值为0.738；Hosmer-Lemeshow拟合优度检验该模型拟合度良好(P=0.686)。结论 医务人员应加强术中管理,充分镇痛,维持血流动力学稳定,降低术中不良事件的发生率,关注男性高龄患者,降低PACU内谵妄的发生。 |
| 中文关键词:麻醉后恢复室 谵妄 影响因素 列线图 森林图 |
| |
| Current Situation and Influencing Factors of Delirium in Patients Undergoing Abdominal Surgery in the Postanesthesia Care Unit. |
|
|
| Abstract:Objective To explore the delirium incidence and risk factors among patients undergoing abdominal surgery in the postanesthesia care unit (PACU), and establish a column chart prediction model. Methods A total of 1851 patients who underwent abdominal surgery, with a surgery duration exceeding 4hours and were routinely transferred to the PACU after surgery in the First Affiliated Hospital of Wenzhou Medical University from January 2022 to December 2023 were selected. The patients were divided into a delirium group and a non-delirium group based on a nursing delirium screening scale score ≥ 2. The relative factors of before and during the surgery were analyzed retrospectively. The LASSO regression was used to screen the variables, and the independent influencing factors were determined using univariate and multivariate Logistic regression before creating a forest plot. The predictive efficacy of the column chart prediction model was evaluated by area under the curve (AUC) of receiver operating characteristic (ROC) and the Hosmer-Lemeshow test. Results A total of 113 (6.1%) patients experienced delirium in the PACU. The result of the multivariate Logistic regression analysis indicated that gender, age, flurbiprofen, hypotension, hypothermia, hypercapnia, and surgery duration were independent influencing factors for delirium in the PACU, while a long surgery duration and using flurbiprofen were protective factors. The nomogram model was constructed based on the result and the AUC value of this model was 0.738. The Hosmer-Lemeshow goodness-of-fit test for the model demonstrated a good fit (P=0.686). Conclusion Medical staff should enhance intraoperative management, ensure sufficient analgesia, maintain hemodynamic stability, reduce the incidence of intraoperative adverse events, pay attention to elderly male patients, and decrease the occurrence of delirium in the PACU. |
| keywords:Postanesthesia care unit Delirium Influence factors Nomogram Forest plot |
| 查看全文 查看/发表评论 下载PDF阅读器 |
|
|
|
