乳腺癌术后患者伤口引流拔管时间延迟预测模型的构建  

Construction of wound drainage tube time delay prediction model for patients with breast cancer

作　　者：贾辛婕 王晴 王淼 何欣 Jia Xinjie;Wang Qing;Wang Miao;He Xin(Second Surgical Department of Breast Cancer of Tianjin Medical University,National Cancer Clinical Research Center,Tianjin Key Laboratory of Cancer Prevention and Treatment,Tianjin Cancer Clinical Research Center,Key Laboratory of Breast Cancer Prevention and Treatment,Ministry of Education,Tianjin 300060,China)

机构地区：[1]天津医科大学肿瘤医院乳腺二科、国家恶性肿瘤临床医学研究中心、天津市肿瘤防治重点实验室、天津市恶性肿瘤临床医学研究中心、乳腺癌防治教育部重点实验室,天津300060

出　　处：《中国实用护理杂志》2023年第2期101-106,共6页Chinese Journal of Practical Nursing

基　　金：天津市护理学会科研课题(tjhlky2021YB07)。

摘　　要：目的探讨乳腺癌术后患者伤口引流拔管时间延迟的独立影响因素并建立预测模型。方法以前瞻性队列研究,选取2021年1—11月在天津医科大学肿瘤医院乳腺科收治的患者为研究对象,按照入组先后时间分为建模组156例和验证组86例。以乳腺癌患者术后伤口引流拔管时间延迟作为终点事件,将建模组156例患者拔管时间≤7 d的95例设为正常组,拔管时间>7 d的61例设为延迟组,比较2组的影响因素,建立预测模型,并进行Hosmer-Lemeshow检验以验证拟合效果,采用ROC曲线来验证模型的预测效能。结果经单因素与多因素Cox比例风险回归分析显示,患者高BMI、有相关基础疾病史、改良根治术、乳腺肿物大小为T3和T4以及术后48 h引流量≥50 ml是伤口引流拔管时间延迟的独立影响因素(P<0.05)。预测模型为P=0.822,ROC曲线下面积为0.877,约登指数为0.605,灵敏度为0.736,特异度为0.869。将验证组86例的研究数据作为测试集进行内外部验证模型,模型验证正确率为96.51%。结论本预测模型效果良好,可以为临床医护工作者实施乳腺癌术后患者伤口引流照护服务提供参考依据。Objective To investigate the independent influencing factors of wound drainage tube time delay in patients with breast cancer and establish a predictive model.Methods Patients admitted to Tianjin Medical University Cancer Hospital from January to November 2021 were selected as the research objects.They were divided into sword modeling group(156 cases)and verification group(86 cases)according to the admission time.Delayed time to postoperative wound drainage and extubation in breast cancer patients was the end point,95 cases of 156 patients in the modeling group whose extubation time was less than or equal to 7 days were set as the normal group,61 cases whose extubation time were more than 7 days were set as delayed group,and the influencing factors of the two groups were compared to establish the prediction model,Hosmer-Lemeshow test was conduct to verify the fitting effect,used the ROC curve to verify the prediction model performance.Results Univariate and multivariate Cox proportional hazards regression analysis showed that patients'high BMI,related basic disease history,operation mode,axillary lymph node dissection,breast tumor size(T3,T4)and drainage fluid volume 48 hours(≥50 ml)after operation were independent influencing factors for wound drainage tube time delay(P<0.05).The prediction model was P=0.822,and the area under the ROC curve was 0.877,and the Youden index was 0.605,the sensitivity was 0.736,and the specificity was 0.869.The research data of 86 cases in the validation group were used as the test set for internal and external validation of the model,and the model verification was 96.51%.Conclusion This prediction model has a good effect,providing a reference basis for clinical medical workers.

关 键 词：乳腺肿瘤 危险因素 外科伤口 引流 预测 拔管时间 

分 类 号：R473.73[医药卫生—护理学]