机械通气患者亚谵妄综合征风险预测模型的构建及验证研究

doi:10.3761/j.issn.2096-7446.2023.12.002

摘要/Abstract

摘要： 目的分析机械通气患者亚谵妄综合征发生的危险因素,构建风险预测模型,以预测亚谵妄的发生。方法采用便利抽样法,选取2021年7月—2022年6月贵州省某三级甲等医院ICU收治的机械通气患者434例,使用ICU患者意识模糊评估表将其分为亚谵妄综合征组（n=136）和非亚谵妄综合征组（n=298）,通过单因素分析和多因素Logistic回归分析探索亚谵妄综合征发生的独立危险因素,建立风险预测模型并构建列线图,并对该模型进行内、外部验证。结果多因素Logistic回归分析显示,年龄（OR=1.029）、急性生理与慢性健康状况评分（OR=1.267）、身体约束（OR=1.029）、重症监护疼痛评分（OR=2.487）、理查兹—坎贝尔睡眠量表评分（OR=1.150）、Richmond躁动—镇静评分（OR=1.500）是亚谵妄综合征发生的独立危险因素。根据上述6项危险因素构建的ICU机械通气患者亚谵妄综合征风险预测模型ROC曲线下面积为0.956,灵敏度为86.2%,特异度为94.1%。结论该研究构建的风险预测模型能有效预测机械通气患者亚谵妄综合征的发生,为临床医护人员科学预测亚谵妄综合征的发生提供参考。

关键词: 机械通气, 亚谵妄综合征, 列线图, 预测模型, 危重病护理

Abstract: Objective To analyze the risk factors for the occurrence of subsyndromal delirium in mechanically ventilated patients and construct a nomogram risk prediction model to predict the occurrence of subsyndromal delirium. Methods Convenience sampling was used to select 434 mechanically ventilated patients admitted to the ICU of a tertiary hospital in Guizhou Province from July 2021 to June 2022,who were categorized into the subdelirium syndrome group（n=136）and the non-subdelirium syndrome group（n=298）using the ICU Patient Ambi-guity of Consciousness Assessment Scale. We explored the independent risk factors for the occurrence of subde-lirium syndrome through univariate and multifactorial logistic regression analyses,established a risk prediction model,developed a nomogram,and validated the model both internally and externally. Results Multifactorial logistic regression analysis revealed that age（OR=1.029）,acute physiological and chronic health status score（OR=1.267）,whether restrained（OR=1.029）,intensive care pain score（OR=2.487）,Richards-Campbell sleep scale score（OR=1.150）,Richmond agitation-sedation score（OR=1.500）were independent risk factors for the development of subdelirium. The consistency index of the nomogram model for the occurrence of subdelirium in mechanically ventilated patients in the ICU was 0.956,with a sensitivity of 86.2% and a specificity of 94.1%. Conclusion The risk prediction model construc-ted in this study can effectively predict the occurrence of subdelirium syndrome in mechanically ventilated patients,which provides a reference for clinical medical personnel to scientifically predict the occurrence of subdelirium.

Key words: Mechanically Ventilated, Subsyndromal Delirium, Nomogram, Prediction Model, Critical Care Nursing

辜甜田, 陈俊希, 杨洋, 肖旭, 李交, 张咏梅. 机械通气患者亚谵妄综合征风险预测模型的构建及验证研究[J]. 中华急危重症护理杂志, 2023, 4(12): 1068-1074.

GU Tiantian, CHEN Junxi, YANG Yang, XIAO Xu, LI Jiao, ZHANG Yongmei. Construction and validation of a nomogram risk prediction model for subsyndromal delirium in mechanically ventilated patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2023, 4(12): 1068-1074.

参考文献

[1] 高燕,甘秀妮,杨睿琦,等. 亚谵妄综合征的概念内涵及研究进展[J]. 中华护理杂志,2021,56(12):1883-1888.
Gao Y,Gan XN,Yang RQ,et al.Conceptual connotation and research progress of subsyndromal delirium[J]. Chin J Nurs,2021,56(12):1883-1888.
[2] 李真,李奇,李尊柱,等. ICU患者亚谵妄综合征患病率及危险因素的系统评价[J]. 中华护理杂志,2020,55(2):288-293.
Li Z,Li Q,Li ZZ,et al.Prevalence and risk factors of subsyndromal delirium among adult intensive care unit patients:a systematic review[J]. Chin J Nurs,2020,55(2):288-293.
[3] Yamada C,Iwawaki Y,Harada K,et al.Frequency and risk factors for subsyndromal delirium in an intensive care unit[J]. Intensive Crit Care Nurs,2018,47:15-22.
[4] Cole MG,Ciampi A,Belzile E,et al.Subsyndromal delirium in older people:a systematic review of frequency,risk factors,course and outcomes[J]. Int J Geriatr Psychiatry,2013,28(8):771-780.
[5] Klimiec-Moskal E,LIS A,Pera J,et al.Subsyndromal delirium is associated with poor functional outcome after ischaemic stroke[J]. Eur J Neurol,2019,26(6):927-934.
[6] Steyerberg EW. Clinical prediction models[M]. Springer US,2009,10.1007/978-0-387-77244-8.
[7] 王潘. 恶性肿瘤晚期患者亚谵妄风险预测模型的构建及验证[D]. 衡阳:南华大学,2022.
Wang P.Construction and verification of subdelirium risk prediction model for patients with advanced malignant tumors[D]. Hengyang:University of South China,2022.
[8] 程晓雪,石萍,刘春兰. 急诊创伤患者亚谵妄发生预测模型的构建及验证研究[J]. 中华急危重症护理杂志,2021,2(6):485-490.
Cheng XX,Shi P,Liu CL.Construction and validation of prediction model of subsyndromal delirium in emergency trauma patients[J]. Chin J Emerg Crit Care Nurs,2021,2(6):485-490.
[9] Riley RD,Ensor J,Snell KIE,et al.Calculating the sample size required for developing a clinical prediction model[J]. BMJ,2020,368:m441.
[10] 邢焕民,吕冬梅,王晓慧,等. 术后谵妄风险预测模型的构建及应用[J]. 中华护理杂志,2019,54(1):8-13.
Xing HM,Lü DM,Wang XH,et al.The development and application of a risk prediction model for postoperative delirium in ICU patients[J]. Chin J Nurs,2019,54(1):8-13.
[11] 邹姮婧. 中文版CAM-ICU的信度效度检验及与其他量表的比较[D]. 武汉:华中科技大学,2012.
Zou HJ.Reliability and validity test of Chinese version of CAM-ICU and comparison with other scales[D]. Wuhan:Huazhong University of Science and Technology,2012.
[12] Knaus WA,Draper EA,Wagner DP,et al.APACHE Ⅱ:a severity of disease classification system[J]. Crit Care Med,1985,13(10):818-829.
[13] 陈杰,杨晓红,路潜,等. 中文版重症监护疼痛观察工具在非气管插管患者中应用的信效度研究[J]. 中华护理杂志,2015,50(9):1132-1136.
Chen J,Yang XH,Lu Q,et al.Reliability and validity of Chinese version of the Critical-Care Pain Observation Tool in non-intubated ICU patients[J]. Chin J Nurs,2015,50(9):1132-1136.
[14] 黄丽,陈巧玲,罗利,等. 中文版重症监护室患者睡眠质量量表的效度与信度[J]. 中国心理卫生杂志,2018,32(5):401-406.
Huang L,Chen QL,Luo L,et al.Validity and reliability of the Chinese version of the Richards-Campbell Sleep Questionnaire[J]. Chin Ment Health J,2018,32(5):401-406.
[15] Sessler CN,Grap MJ,Brophy GM.Multidisciplinary management of sedation and analgesia in critical care[J]. Semin Respir Crit Care Med,2001,22(2):211-226.
[16] Sessler CN,Gosnell MS,Grap MJ,et al.The Richmond Agitation-Sedation Scale:validity and reliability in adult intensive care unit patients[J]. Am J Respir Crit Care Med,2002,166(10):1338-1344.
[17] 李京连,冯雅笛,姚菲,等. 颅脑肿瘤术后ICU患者亚谵妄发生情况及影响因素研究[J]. 中华现代护理杂志,2019,25(30):3854-3858.
Li JL,Feng YD,Yao F,et al.Incidence and influencing factors of subsyndromal delirium in ICU patients after surgery for craniocerebral tumor[J]. Chin J Mod Nurs,2019,25(30):3854-3858.
[18] 董亮. 重症监护病房患者ICU综合征发生状况及影响因素的研究[D]. 北京:北京协和医学院,2011.
Dong L.Study on the incidence and influencing factors of ICU syndrome in ICU patients[D]. Beijing:Peking Union Medical College,2011.
[19] Ayasrah S.Care-related pain in critically ill mechanically ventilated patients[J]. Anaesth Intensive Care,2016,44(4):458-465.
[20] Devlin JW,Skrobik Y,Gélinas C,et al.Clinical practice guidelines for the prevention and management of pain,agitation/sedation,delirium,immobility,and sleep disruption in adult patients in the ICU[J]. Crit Care Med,2018,46(9):e825-e873.
[21] Mo Y,Scheer CE,Abdallah GT.Emerging role of melatonin and melatonin receptor agonists in sleep and delirium in intensive care unit patients[J]. J Intensive Care Med,2016,31(7):451-455.
[22] Wang HB,Zhang L,Luo QP,et al.Effect of sleep disorder on delirium in post-cardiac surgery patients[J]. Can J Neurol Sci,2020,47(5):627-633.
[23] Sanson G,Khlopenyuk Y,Milocco S,et al.Delirium after cardiac surgery. Incidence,phenotypes,predisposing and precipitating risk factors,and effects[J]. Heart Lung,2018,47(4):408-417.