目的: 建立学龄前儿童全麻斜视矫正术后苏醒期谵妄的列线图模型,以早期识别危险因素,采取针对性措施。方法: 选取2021年1月—2021年10月全麻下接受斜视矫正术治疗的317例学龄前儿童为研究对象,于患儿苏醒期进行谵妄和疼痛评估,采用Logistic回归分析患儿出现苏醒期谵妄的影响因素,运用R软件构建预测学龄前儿童全麻斜视矫正术后发生苏醒期谵妄的风险列线图模型。结果: 317例患儿中有67例（21.1%）出现苏醒期谵妄,并根据其是否发生术后谵妄分为谵妄组（n=67）和非谵妄组（n=250）。单因素结果显示,谵妄组的患儿在年龄≤3岁、美国麻醉医师协会（ASA）分级Ⅱ级、重度疼痛的比例和手术时长高于非谵妄组;Logistic回归分析显示患儿年龄（OR=4.588,95%CI：2.401~8.768）、ASA分级（OR=4.102,95%CI：2.125~7.922）、疼痛程度（OR=3.589,95%CI：2.358~5.463）是学龄前儿童斜视矫正术后苏醒期谵妄的危险因素。对列线图进行验证,校准曲线拟合良好,AUC（95%CI）为0.841（0.789~0.894）,灵敏度和特异度分别为80.80%（95%CI：75.4%~85.5%）和71.64%（95%CI：59.3%~82.0%）。结论: 学龄前儿童斜视矫正术后存在一定的谵妄风险,低年龄组、ASA分级较高、中重度疼痛是患儿更易发生苏醒期谵妄的危险因素,据此构建的列线图模型对患儿发生苏醒期谵妄有较好预测价值,提示医护人员需要在儿童围术期提供个性化管理。
Abstract
Objective To establish the nomogram model of delirium in preschool children after strabismus correction under general anesthesia in order to identify risk factors early and take targeted measures. Methods 317 preschool children who were treated with strabismus correction under general anesthesia from January 2021 to October 2021 were selected as the study objects. Delirium and pain were evaluated during the awakening period of the children. Logistic regression was used to analyze the influencing factors of delirium in the awakening period, and R software was used to construct a nomogram model to predict the risk of delirium after strabismus correction under general anesthesia in preschool children. Results Among 317 children, 67(21.1%) had delirium in the awakening period, and were divided into delirium group (n=67) and non delirium group (n=250) according to whether they had postoperative delirium. The univariate results showed that children in the delirium group had higher proportion of aged≤3 years old, the American Association of Anesthesiologists (ASA) grade II, severe pain and longer operation duration than that in the non-delirium group; Logistic regression analysis showed that the age (OR=4.588, 95%CI: 2.401~8.768), ASA grade (OR=4.102, 95%CI: 2.125~7.922) and pain degree (OR=3.589, 95%CI: 2.358~5.463) of preschool children were the risk factors for delirium after strabismus correction. The nomogram was verified, and the calibration curve fit well, and the AUC (95%CI) was 0.841(0.789~0.894), the sensitivity and specificity were 80.80% (95% CI: 75.4%~85.5%) and 71.64% (95% CI: 59.3%~82.0%), respectively . Conclusion There is a certain risk of delirium in preschool children after strabismus correction. Low age group, higher ASA grade and moderate to severe pain are the risk factors for children to develop delirium in the awakening period. The nomogram model constructed on this basis has a good predictive value for the occurrence of delirium in children during awakening, which suggests that medical personnel need to provide personalized management in the perioperative period of children.
关键词
学龄前儿童 /
斜视矫正术 /
谵妄 /
影响因素 /
列线图
Key words
preschool children /
strabismus correction /
delirium /
influence factor /
nomogram
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基金
江苏省妇幼保健协会科研项目（FYX202112）
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