腹腔镜前列腺癌根治术患者出院准备度预警模型的构建  

Construction of warning model for discharge readiness of patients undergoing laparoscopic radical prostatectomy

作　　者：汤爱玲[1] 许方蕾[2] TANG Ailing;XU Fanglei(Department of Urological Surgery,Shanghai Tongji Hospital,Shanghai,200065;Department of Nursing,Shanghai Tongji Hospital,Shanghai,200065)

机构地区：[1]上海市同济医院泌尿外科,上海200065 [2]上海市同济医院护理部,上海200065

出　　处：《实用临床医药杂志》2023年第20期16-20,25,共6页Journal of Clinical Medicine in Practice

基　　金：上海市普陀区护理课题重点项目(2023PTHL01);上海市护理学会面上项目(2021MS-B11)。

摘　　要：目的分析腹腔镜前列腺癌根治术(LRP)患者出院准备度的现状和影响因素,构建预警模型。方法采用便利抽样方法选取162例LRP患者作为研究对象,于患者出院当日采用一般资料和疾病相关资料调查表、出院准备度量表收集相关信息,分析LRP术后患者出院准备度的影响因素并构建预警模型。结果45例患者出院当日未做好出院准备,占27.78%。二元Logistic回归分析结果显示,入院时排尿功能障碍(OR=0.091,95%CI:0.029~0.290)、术前PSA(OR=0.847,95%CI:0.728~0.986)、术前前列腺体积(OR=0.838,95%CI:0.782~0.898)和Barthel指数评分(OR=1.128,95%CI:1.086~1.173)均为LRP术后患者出院准备度的独立预测因素(P<0.05)。LRP术后患者出院准备度的预警模型公式为Y=-24.0×X_(1)-1.7×X_(2)-1.8×X_(3)+2.4×X_(4),其中Y为出院准备度,X_(1)为排尿功能障碍(否=0,是=1),X_(2)为术前PSA,X_(3)为术前前列腺体积,X_(4)为Barthel指数评分。受试者工作特征曲线显示,预警模型预测LRP术后患者出院准备度的曲线下面积为0.951(95%CI:0.916~0.985),约登指数为0.811,最佳临界值为8分;Hosmer-Lemeshow拟合优度检验结果显示,χ^(2)=4.864,P=0.772。结论LRP术后患者出院准备度预警模型效能较好,可为临床实施早期、强化的出院健康指导及拟定相关决策提供参考依据。Objective To analyze the status quo and influencing factors of discharge readiness of patients undergoing laparoscopic radical prostatectomy(LRP),and establish an warning model.Methods A total of 162 patients undergoing LRP were recruited as participants using convenience sampling.At discharge,general data and disease-related information questionnaires were used to collect related information,and the influencing factors of hospital discharge readiness of patients after LRP were analyzed and an early warning model was established.Results A total of 45 participants did not prepare well for hospital discharge,accounting for 27.78%.Binary Logistic regression analysis showed that urinary dysfunction on admission(OR=0.091;95%CI,0.029 to 0.290),preoperative PSA(OR=0.847;95%CI,0.728 to 0.986),preoperative prostate volume(OR=0.838;95%CI,0.782 to 0.898)and Barthel index score(OR=1.128;95%CI,1.086 to 1.173)were independent predictors of hospital readiness after LRP(P<0.05).The warning model predicting discharge readiness for patients undergoing LRP was as follows:Y=-24.0×X_(1)-1.7×X_(2)-1.8×X_(3)+2.4×X_(4)[Y referring to discharge readiness;X_(1)referring to urination dysfunction(no=0,yes=1),X_(2)referring to preoperative PSA,X_(3)referring to preoperative prostate volume,X_(4)referring to Barthel score].The receiver operating characteristic curve showed that the area under the curve of warning model to predict the discharge readiness of patients after LRP was 0.951(95%CI,0.916 to 0.985),the Jorden index was 0.811,and the optimal critical value was 8 points.The Hosmer-Lemeshow goodness of fit test showed that the chi-square value was 4.864 and P value was 0.772.Conclusion The early warning model of discharge readiness of patients after LRP operation has a good efficacy,and can provide a reference for the implementation of early and intensive discharge health guidance and the formulation of relevant decisions.

关 键 词：前列腺癌 出院准备度 预警模型 出院健康指导 加速康复外科 护理 

分 类 号：R473.6[医药卫生—护理学] R473.73[医药卫生—临床医学]