临终病人生存期评估表对安宁疗护病人30 d和90 d死亡风险的预测效果  

Predictive effect of Survival Scale for End⁃of⁃Life Patients on the risk of death at 30 and 90 days in patients receiving palliative care

作　　者：李强 曹梅娟[1] 包彬 谢纯琦 王先益 朱敏江 LI Qiang;CAO Meijuan;BAO Bin;XIE Chunqi;WANG Xianyi;ZHU Minjiang(School of Nursing,Hangzhou Normal University,Zhejiang 311121 China;不详)

机构地区：[1]杭州师范大学护理学院,浙江311121 [2]浙江省民政事业发展促进会

出　　处：《护理研究》2023年第21期3793-3798,共6页Chinese Nursing Research

基　　金：国家社会科学基金项目,编号:19BSH034;2023年研究生“创新实践与服务地方”计划“勤慎研创”项目,编号:YJS2023110。

摘　　要：目的:探讨临终病人生存期评估表对安宁疗护病人30 d、90 d死亡风险的预测效果。方法:回顾264份接受福彩公益金资助“老年人临终关怀救助服务”项目的病人的电子病历及服务记录,评估临终病人生存期评分与生存期的相关性,分析影响病人30 d、90 d死亡风险的主要因素,再根据临终病人生存期评分,绘制受试者工作特征(ROC)曲线分析评估生存期<30 d、90 d的最佳评分界值。结果:264例病人服务期间死亡231例,删失33例。231例病人接受服务后生存期为(32.96±1.91)d,中位生存期为24 d;临终病人生存期评分与病人生存期呈正相关(r=0.822,P<0.05);Kaplan-Meier生存曲线分析结果显示,临终病人30 d、90 d生存期评估表评分差异有统计学意义(P<0.05);Cox回归分析显示,临终病人生存期评分为安宁疗护病人30 d、90 d死亡风险的独立影响因素;ROC曲线提示,临终病人生存期评估表预测病人生存期<30 d、<90 d的最佳评分界值为44.5分、49.5分,ROC曲线下面积(AUC)分别为0.913,0.884(均P<0.05),即当临终病人生存期评分<44.5分、49.5分时,临终病人生存期评估表预测生存期<30 d、<90 d的灵敏度分别为83.8%、100.0%,特异度为83.3%、68.5%,约登指数为0.671,0.684。结论:临终病人生存期评估表评分与安宁疗护病人生存期相关,能够有效预测病人临终阶段的生存期,并为安宁疗护实践提供一定参考。Objective:To evaluate the predictive effect of the survival scale for end-of-life patients on 30-day and 90-day mortality risk of patients receiving palliative care.Methods:The electronic medical records and service records of 264 patients who received"Hospice Care for the Elderly"project funded by public welfare fund were reviewed.The correlation between the survival time score and survival time was evaluated,and the main factors affecting the 30-day and 90-day mortality risk of the patients were analyzed.Receiver operating characteristic(ROC)curve analysis was used to evaluate the optimal cut-off value of survival<30 days and 90 days.Results:The average survival time of 264 patients was(32.96±1.91)days,and the median survival time was 24 days.The survival score of terminal patients was significantly positively correlated with the survival time of patients(r=0.822,P<0.05).Kaplan-Meier survival curve analysis showed that there was a statistically significant difference between 30-day and 90-day survival scores stratification by Survival Scale for End-of-Life Patients(P<0.05).Cox regression showed that the survival score of terminal patients was an independent influencing factor of 30-day and 90-day mortality risk of hospice care patients.The ROC curve suggested that the best score threshold values for predicting survival<30 days and<90 days were 44.5 points and 49.5 points,AUC were 0.913,0.884,P<0.05;When the survival score of terminal patients was less than 44.5 points and 49.5 points,the sensitivity of predicting survival less than 30 days and 90 days was 83.8%and 100.0%,the specificity was 83.3%and 68.5%,and the Youden index was 0.671 and 0.684.Conclusions:The score of Survival Scale for End-of-Life Patients is correlated with the survival time of hospice care patients,which can effectively predict the survival time of terminal stage and provide some references for practice of hospice care.

关 键 词：临终病人生存期评估表 安宁疗护 生存期 影响因素 预测 调查研究 

分 类 号：R48[医药卫生—临床医学]