结肠癌全身麻醉患者围手术期神经认知紊乱的影响因素及列线图预测模型构建

陶伟; 夏晓琼; 代镇; 李锐

doi:10.12182/20260360606

结肠癌全身麻醉患者围手术期神经认知紊乱的影响因素及列线图预测模型构建

Perioperative Neurocognitive Disorders in Patients With Colorectal Cancer Undergoing General Anesthesia: Influencing Factors and Development of a Nomogram Prediction Model

摘要

摘要:
目的基于列线图构建结肠癌全身麻醉患者围手术期神经认知紊乱（perioperative neurocognitive disorders, PND）的风险预测模型。
方法选取2021年8月–2024年12月行全身麻醉下结肠癌手术的患者207例，按照7∶3的比例随机分为建模队列（n=145）和验证队列（n=62）。根据患者是否发生PND，将建模队列分为PND组（n=42）和非PND组（n=103），验证队列分为PND组（n=18）和非PND组（n=44）。Logistic回归分析结肠癌全身麻醉患者发生PND的影响因素，并构建列线图预测模型，绘制受试者工作特征（receiver operating characteristic, ROC）曲线和校准曲线，行Hosmer-Lemeshow拟合优度检验。
结果单因素分析显示，PND组与非PND组患者年龄、手术时间、麻醉深度、术中出血量、术中平均局部脑氧饱和度（regional brain oxygen saturation, rSO₂）、血小板平均体积（mean platelet volume, MPV）、血小板分布宽度（platelet distribution width, PDW）、疼痛视觉模拟（visual analog scale, VAS）、睡眠质量指数（Pittsburgh Sleep Quality Index, PSQI）差异存在统计学意义（P<0.05）；Logistic多因素分析显示，年龄、麻醉深度、术中平均rSO₂、MPV、PDW、VAS、PSQI均是结肠癌全身麻醉患者发生PND的影响因素（P<0.05）；列线图模型ROC曲线下AUC为0.861（95%置信区间：0.786～0.935），在验证队列中AUC为0.827（95%：0.752～0.902）；校准曲线分析结果发现，预测患者发生PND的风险和实际发生情况基本吻合，Hosmer-Lemeshow结果显示模型拟合优度较高；临床决策曲线结果显示该模型临床应用价值较高。
结论高龄、麻醉深度过浅、术中平均rSO₂低、血清MPV与PDW升高、疼痛程度较重及睡眠质量下降是结肠癌全身麻醉患者PND的影响因素；基于上述因素建立的列线图模型具有良好的预测能力。

Abstract:
Objective To develop a risk prediction model for perioperative neurocognitive disorders (PND) in patients with colorectal cancer undergoing general anesthesia based on a nomogram.
Methods A total of 207 patients undergoing colorectal cancer surgery under general anesthesia from August 2021 to December 2024 were enrolled and randomly divided into a modeling cohort (n = 145) and a validation cohort (n = 62) at a 7∶3 ratio. Based on the occurrence of PND, the modeling cohort was further divided into PND group (n = 42) and non-PND group (n = 103), while the validation cohort was divided into PND group (n = 18) and non-PND group (n = 44). Logistic regression analysis was performed to identify influencing factors for PND in patients with colorectal cancer undergoing general anesthesia, and a nomogram prediction model was constructed. Receiver operating characteristic (ROC) curves and calibration curves were plotted, and Hosmer-Lemeshow goodness-of-fit test was conducted.
Results Univariate analysis showed statistically significant differences between PND group and non-PND group in age, operative time, anesthesia depth, intraoperative blood loss, intraoperative mean regional brain oxygen saturation (rSO₂), mean platelet volume (MPV), platelet distribution width (PDW), visual analog scale (VAS) for pain, and Pittsburgh Sleep Quality Index (PSQI) (P < 0.05). Multivariate Logistic regression analysis revealed that age, anesthesia depth, intraoperative mean rSO₂, MPV, PDW, VAS, and PSQI were all influencing factors for PND in patients with colorectal cancer undergoing general anesthesia (P < 0.05). The area under the ROC curve (AUC) of the nomogram model was 0.861 (95% CI: 0.786-0.935) in the modeling cohort and 0.827 (95% CI: 0.752-0.902) in the validation cohort. Calibration curve analysis indicated that the predicted risk of PND was largely consistent with the actual incidence, and the Hosmer-Lemeshow test showed good model fit. Clinical decision curve analysis demonstrated high clinical applicability of the model.
Conclusion Advanced age, excessively light anesthesia depth, low intraoperative mean rSO₂, elevated serum MPV and PDW, severe pain, and poor sleep quality are influencing factors for PND in patients with colorectal cancer undergoing general anesthesia. The nomogram model established based on these factors exhibits good predictive performance.

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