无抽搐电休克治疗并发肺炎的临床特点及预警模型

Clinical characteristics and early warning model of pneumonia in patients undergoing modified electroconvulsive therapy

摘要:

目的 分析无抽搐电休克治疗（MECT）患者并发肺炎的临床特点，构建并验证预警模型。方法 回顾性分析2023年2月—2024例2月广州医科大学附属脑科医院1 802例行MECT的精神疾病患者的临床资料。MECT期间或终止治疗48 h内，根据患者是否并发肺炎分为并发组与非并发组。对比两组临床资料，多因素逐步Logistic回归模型分析MECT患者并发肺炎的影响因素，构建并验证MECT患者并发肺炎的风险预测模型。结果 1 802例MECT患者中，发生肺炎69例，发生率为3.83%（69/1 802），其中46例吸入性肺炎、23例坠积性肺炎。并发组抗精神病药物、呼吸恢复时间、年龄≥ 60岁、抽搐发作时间、吞咽困难均高于非并发组（P <0.05）。多因素逐步Logistic回归分析结果显示，使用抗精神病药物［O^R=5.150（95% CI：2.264，11.715］、年龄［O^R=5.613（95% CI：2.467，12.767）］、抽搐发作时间［O^R=3.842（95% CI：1.689，8.740）］、吞咽困难［O^R=4.563（95% CI：2.006，10.380）］为MECT患者并发肺炎的危险因素（P <0.05）。列线图模型预测MECT患者并发肺炎的敏感性为79.71%（95% CI：0.680，0.881），特异性为91.06%（95% CI：0.896，0.923），曲线下面积为0.904（95% CI：0.809，0.965）。结论 MECT患者并发吸入性肺炎的风险较高，使用抗精神病药物、较高年龄、较长抽搐发作时间、吞咽困难与MECT患者并发肺炎有关，构建风险预警模型有助于早期筛查MECT患者并发肺炎风险。

Abstract:

Objective To analyze the clinical characteristics of pneumonia complicated with modified electroconvulsive therapy (MECT) and construct and validate an early warning model.Methods A retrospective analysis was conducted on the clinical data of 1802 psychiatric patients who underwent MECT treatment at Guangzhou Medical University Affiliated Brain Hospital from February 2023 to February 2024. During or within 48 hours of terminating MECT treatment, patients were divided into pneumonia group and non-pneumonia group based on whether pneumonia occurred. The clinical data of the two groups were compared to analyze the influencing factors of pneumonia in MECT patients and to construct and validate a risk prediction model for pneumonia in MECT patients.Results Among 1802 MECT patients, 69 cases developed pneumonia, the incidence rate was 3.83% (69 cases /1802 cases), including 46 cases of aspiration pneumonia and 23 cases of hypostatic pneumonia. The proportion of antipsychotic drugs, respiratory recovery time, age ≥ 60 years, convulsive onset time and dysphagia in the concurrent group were higher than those in the non-concurrent group (P <0.05). Logistic regression analysis showed that the use of antipsychotics [O^R = 5.150 (95% CI: 2.264, 11.715)], age [O^R = 5.613 (95% CI: 2.467, 12.767)], duration of convulsions [O^R = 3.842 (95% CI: 1.689, 8.740)], dysphagia [O^R = 4.563 (95% CI: 2.006, 10.380)] were risk factors for pneumonia in MECT patients (P <0.05). The sensitivity, specificity and area under the curve were 79.71% (95% CI: 0.680, 0.881), 91.06% (95% CI: 0.896, 0.923), and 0.904 (95% CI: 0.809, 0.965) for predicting pneumonia in MECT patients.Conclusion MECT patients have a higher risk of developing aspiration pneumonia. The use of antipsychotic drugs, older age, longer seizure duration, and swallowing difficulty are associated with pneumonia in MECT patients. Constructing a risk early warning model can help in early screening for the risk of pneumonia in MECT patients.