乳腺癌患者手术麻醉苏醒后24 h内支持性照护需求预测模型的构建与验证

Construction and validation of a predictive model for supportive care needs within 24 hours after surgical anesthesia recovery in breast cancer patients

  • 摘要:
    目的 构建并验证乳腺癌患者手术麻醉苏醒后24 h内支持性照护需求的精准预测模型。
    方法 回顾性分析2022年6月—2024年6月在本院手术治疗的156例乳腺癌患者的资料, 根据手术麻醉苏醒后24 h内支持性照护需求分为无和低需求组(n=41)和中高需求组(n=115)。通过单因素方差分析2组临床相关资料,采用二元Logistic回归模型分析乳腺癌患者手术麻醉苏醒后24 h内支持性照护需求的相关影响因素,并构建预测模型。
    结果 二元Logistic回归模型分析结果显示,医疗费用来源(非城镇医疗保险)、职业(工人)、主要照顾者(配偶)、安德森症状评估量表(MDASI)评分、麻醉恢复质量量表(QoR)评分均是乳腺癌患者手术麻醉苏醒后24 h支持性照护需求的影响因素(P < 0.05)。受试者工作特征(ROC)曲线分析显示,医疗费用来源、职业、主要照顾者、MDASI评分、QoR评分预测乳腺癌患者手术麻醉苏醒后24 h支持性照护需求的曲线下面积(AUC)分别为0.635、0.723、0.618、0.742、0.749。预测模型数据预测乳腺癌患者手术麻醉苏醒后24 h内支持性照护需求的AUC为0.965, 敏感度、特异度分别为93.0%、90.2%。利用Bootstrap法对模型进行内部验证,自抽样次数B=1 000, 该预测模型整体预测准确性为88.5%, 预测效能较好。
    结论 医疗费用来源(非城镇医疗保险)、职业(工人)、主要照顾者(配偶)、MDASI评分、QoR评分均是乳腺癌患者手术麻醉苏醒后24 h内支持性照护需求的影响因素,基于上述因素构建的预测模型的预测价值较好,可为术后护理路径优化提供量化决策工具。

     

    Abstract:
    Objective To construct and validate a precise predictive model for supportive care needs within 24 hours after surgical anesthesia recovery in breast cancer patients.
    Methods A retrospective analysis was conducted on data of 156 breast cancer patients who underwent surgical treatment in the hospital from June 2022 to June 2024. Based on their supportive care needs within 24 hours after surgical anesthesia recovery, the patients were divided into no and low demand group (n=41) and moderate and high demand group (n=115). Clinical data of the two groups were compared using one-way analysis of variance. Binary Logistic regression analysis was employed to identify factors influencing supportive care needs within 24 hours after surgical anesthesia recovery in breast cancer patients, and a predictive model was constructed accordingly.
    Results Binary Logistic regression analysis revealed that sources of medical expenses (non-urban medical insurance), occupation (worker), primary caregiver (spouse), the M. D. Anderson Symptom Inventory (MDASI) score, and Quality of Recovery (QoR) score were all influencing factors for supportive care needs within 24 hours after surgical anesthesia recovery in breast cancer patients (P < 0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for predicting supportive care needs within 24 hours after surgical anesthesia recovery in breast cancer patients was 0.635 for sources of medical expenses, 0.723 for occupation, 0.618 for primary caregiver, 0.742 for MDASI score, and 0.749 for QoR score, respectively. The AUC of the predictive model for supportive care needs within 24 hours after surgical anesthesia recovery in breast cancer patients was 0.965, with a sensitivity of 93.0% and a specificity of 90.2%. Internal validation of the model using the Bootstrap method with B=1, 000 self-sampling times demonstrated an overall predictive accuracy of 88.5%, indicating good predictive performance.
    Conclusion Sources of medical expenses (non-urban medical insurance), occupation (worker), primary caregiver (spouse), MDASI score, and QoR score are all influencing factors for supportive care needs within 24 hours after surgical anesthesia recovery in breast cancer patients. The predictive model constructed based on these factors exhibits good predictive value and can serve as a quantitative decision-making tool for optimizing postoperative nursing pathways.

     

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