摘要
目的:分析影响老年肺癌患者胸腔镜下根治切除术后发生谵妄的危险因素,基于上述影响因素构建个体化的列线图模型,并验证该列线图模型预测的准确性和临床有效性。方法:回顾性分析2016年01月01日至2021年01月01日我院行胸腔镜下肺癌根治切除术的老年肺癌患者临床资料,挑选符合入组的患者,以是否发生术后谵妄为结局变量,探讨患者相关临床指标、围手术期相关指标以及实验相关指标对术后是否发生谵妄的影响,采用单因素以及多因素logistics分析影响老年肺癌胸腔镜下切除术后发生谵妄的危险因素,利用R语言包构建列线图模型,并利用Bootstrap方法以及临床决策曲线验证该模型的准确性和临床决策的获益性。结果:最终纳入284例患者,284例患者中术后发生谵妄的患者为32例,发生比例为11.27%,通过多因素logistics分析显示导致术后谵妄发生的独立危险因素为:COPD病史,PO 2,BMI,ASA分级,术中单肺通气时间,术中丙泊酚用量以及术后地佐辛用量;ROC曲线验证列线图模型显示:构建的列线图个体化预测老年肺癌胸腔镜下切除术后发生谵妄能力较强,其中AUC=0.858,95%CI 0.71~0.92,随后采用Bootstrap方法重复抽样1000次验证列线图,发现校准曲线的平均绝对误差为0.016,说明校准曲线与理想曲线贴合良好;临床决策曲线显示,列线图模型预测老年肺癌胸腔镜下根治切除术后发生谵妄的发生阈值为0.06~0.87之间时该模型图的适用性最佳。结论:影响老年肺癌患者胸腔镜下根治切除术后发生谵妄的独立危险因素为:COPD病史,PO 2,BMI,ASA分级,术中单肺通气时间,术中丙泊酚用量以及术后地佐辛用量,基于上述危险因素构建的列线图模型对于老年肺癌胸腔镜下根治切除术后发生谵妄预测准确,且临床应用价值较高。
Objective:To analyze the risk factors of delirium after thoracoscopic radical resection in elderly patients with lung cancer,build an individualized nomogram model based on the above influencing factors,and verify the prediction accuracy and clinical validity of the nomogram model.Methods:The clinical data of elderly patients with lung cancer who underwent thoracoscopic radical resection of lung cancer in our hospital from January 1,2016 to January 1,2021 were retrospectively analyzed,and eligible patients were selected,and postoperative delirium was used as the outcome variable.The effects of patient-related clinical indicators,perioperative-related indicators,and experimental-related indicators on the occurrence of postoperative delirium were explored.Univariate and multivariate logistical analysis was used to analyze the risk factors of delirium after thoracoscopic resection of lung cancer in elderly patients.The R language package was used to construct a nomogram model,and the Bootstrap method and the clinical decision curve were used to verify the accuracy of the model and the benefit of clinical decision-making.Results:A total of 284 patients were finally included.Among the 284 patients,32 patients had postoperative delirium,and the incidence rate was 11.27%.The multivariate logistic analysis showed that the independent risk factors for postoperative delirium were:History of COPD,PO 2,BMI,ASA classification,intraoperative one-lung ventilation time,intraoperative propofol dosage,and postoperative dezocine dosage.ROC curve validation nomogram model showed:The ability of constructed nomogram individually predicting the delirium after thoracoscopic resection of elderly lung cancer was strong,with AUC=0.858,95%CI 0.71~0.92,and then the Bootstrap method was used to repeat sampling 1000 times to verify the nomogram,and it was found that the mean absolute error of the calibration curve was 0.016,indicating that the calibration curve could fit the ideal curve well.The clinical decision curve showed that the nomogram model has the best applicability when the threshold for delirium after thoracoscopic radical resection of elderly lung cancer was between 0.06 and 0.87.Conclusion:The independent risk factors for delirium after thoracoscopic radical resection in elderly patients with lung cancer are COPD,PO 2,BMI,ASA classification,intraoperative one-lung ventilation time,intraoperative propofol dosage and postoperative dezocine dosage.The nomogram model constructed by risk factors is accurate in predicting delirium after thoracoscopic radical resection of lung cancer in elderly patients,and has high clinical application value.
作者
刘微
关丹丹
张洪岩
LIU Wei;GUAN Dandan;ZHANG Hongyan(First Department of Thoracic Surgery,Shengjing Hospital Affiliated to China Medical University,Liaoning Shenyang 110004,China.)
出处
《现代肿瘤医学》
CAS
2024年第6期1054-1059,共6页
Journal of Modern Oncology
基金
辽宁省教育厅科学研究经费项目(编号:QN2019015)。
关键词
胸腔镜
肺癌
谵妄
列线图模型
thoracoscopy
lung cancer
delirium
nomogram model
