中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2024, Vol. 22 ›› Issue (2): 175-180.doi: 10.19438/j.cjoms.2024.02.011

• 论著 • 上一篇    下一篇

儿童阻塞性睡眠呼吸暂停综合征全麻苏醒期躁动风险预测模型的构建与验证

王家慧1#, 段晓雯1,2#, 周徐慧1, 仇琳1, 李静洁1, 蔡美华1,*, 郑永超1,*   

  1. 1.上海交通大学医学院附属第九人民医院 麻醉科,上海 200011;
    2.南京医科大学附属脑科医院 麻醉科,江苏 南京 210029
  • 收稿日期:2023-10-08 修回日期:2023-11-21 发布日期:2024-03-27
  • 通讯作者: 蔡美华,E-mail: 2017220632@qq.com;郑永超,E-mail: yongchao0110@163.com。*共同通信作者
  • 作者简介:王家慧（1991-）,女,硕士,E-mail: 992351349@qq.com;段晓雯（1991-）,女,硕士,E-mail: 1633780685@qq.com。#并列第一作者

Construction and validation of a risk prediction model for emergence agitation in children with obstructive sleep apnea syndrome

WANG Jia-hui1#, DUAN Xiao-wen1,2#, ZHOU Xu-hui1, QIU Lin1, LI Jing-jie1, CAI Mei-hua1*, ZHENG Yong-chao1*   

  1. 1. Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;
    2. Department of Anesthesiology, Brain Hospital Affiliated to Nanjing Medical University. Nanjing 210029, Jiangsu Province, China
  • Received:2023-10-08 Revised:2023-11-21 Published:2024-03-27

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摘要： 目的: 构建并验证儿童阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome,OSAS）术后苏醒期躁动（emergence agitation,EA）的风险预测模型。方法: 选择665例全麻下行OSAS手术的3~12岁患儿为研究对象,随机分为建模组(n=499)和验证组(n=166)。建模组根据是否发生苏醒期躁动,分为EA组和非EA组,采用logistic回归分析筛选儿童OSAS术后EA的危险因素,以此建立风险预测列线图模型,并通过C-index、校准曲线和受试者工作特征曲线（ROC）下面积验证模型的预测效能,并用该风险模型进行内部验证。采用SPSS 26.0软件包和R软件(V4.1.2) 对数据进行统计学分析。结果: OSAS手术后患儿苏醒期躁动发生率为38.68%。Logistic回归分析显示,年龄（OR:0.494,95%CI:0.313~0.778）、拔管时间（OR:0.971,95%CI:0.953~0.990）、术后疼痛（OR:1.530,95%CI:1.378~1.699）是儿童OSAS手术后苏醒期躁动的独立危险因素（P<0.05）。据此建立风险预测模型,ROC曲线下面积为0.782(95%CI: 0.741~0.823),灵敏度为0.599,特异度为0.837。验证组的ROC曲线下面积为0.773（95%CI: 0.697~0.849）,灵敏度0.676,特异度为0.814。结论: 年龄、拔管时间、术后疼痛是OSAS儿童术后苏醒期躁动的独立危险因素,以此构建的列线图模型对此类患儿术后苏醒期躁动的发生有较好的预测效能。

关键词: 儿童, 阻塞性睡眠呼吸暂停综合征, 全身麻醉, 苏醒期躁动

Abstract: PURPOSE: To construct and validate the risk prediction model of emergence agitation (EA) after surgery in children with obstructive sleep apnea syndrome(OSAS). METHODS: A total of 665 children aged 3-12 years who received OSAS surgery under general anesthesia were selected as the study subjects and randomly divided into modeling group (n=499) and verification group (n=166). According to the occurrence of emergence agitation, the patients were divided into EA group and non-EA group. Logistic regression analysis was used to screen the risk factors of EA after OSAS in children, so as to establish a risk prediction nomogram model. The prediction efficiency of the model was verified by the area under C-index, calibration curve and receiver operating characteristic curve (ROC), and the risk model was internally verified. SPSS 26.0 software package and R software (V4.1.2) were used for data analysis. RESULTS: The incidence of emergence agitation after OSAS operation was 38.68%. Logistic regression analysis showed that age(OR: 0.494, 95%CI: 0.313-0.778), extubation time(OR: 0.971, 95%CI: 0.953-0.990) and postoperative pain (OR: 1.530, 95%CI: 1.378-1.699) were independent risk factors for emergence agitation after OSAS operation in children (P<0.05). Based on these findings, a risk prediction model was established, and the area under ROC curve was 0.782(95%CI: 0.741-0.823), the sensitivity was 0.599, the specificity was 0.837. The area under ROC curve of the verification group was 0.773 (95%CI: 0.697-0.849), the sensitivity was 0.676, and the specificity was 0.814. CONCLUSIONS: Age, extubation time and postoperative pain are independent risk factors for the occurrence of emergence agitation in children with OSAS operation, and the nomogram model constructed by this method has a good predictive effect on emergence agitation in children with OSAS operation.

Key words: Children, General anesthesia, Obstructive sleep apnea syndrome, Emergence agitation

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