乳腺癌根治术后淋巴水肿患者康复护理模式构建  

Rehabilitation nursing model construction for patients with lymphedema after radical surgery for breast cancer

作　　者：袁红[1] 谭凤仙[1] 王倩琳[1] 罗丽燕[1] 常颖智[1] 黄迪[1] YUAN Hong;TAN Fengxian;WANG Qianlin;LUO Liyan;CHANG Yingzhi;HUANG Di(Guangzhou First People's Hospital,Guangzhou 510180,China)

机构地区：[1]广州市第一人民医院,广东省广州市510180

出　　处：《护理实践与研究》2024年第11期1629-1635,共7页Nursing Practice and Research

基　　金：广州市第一人民医院红棉计划项目(编号:2023HL14)。

摘　　要：目的分析乳腺癌根治术后患者发生淋巴水肿的影响因素,基于独立影响因素构建风险预测模型,并以此构建有针对性的康复护理模式。方法选取2020年9月—2022年8月医院接受乳腺癌根治术治疗的患者212例为研究对象,根据患者术后1年内是否发生淋巴水肿,将患者分为并发淋巴水肿组63例和未并发淋巴水肿组149例,通过单因素分析及多因素Logistic回归分析得出独立影响因素,并基于回归分析法构建风险预测模型,使用R语言软件绘制相应的列线图,采用受试者工作特征(ROC)曲线及校准曲线检验预测效能,并以此构建患者康复护理模式。结果经过多因素Logistic回归分析,本研究结果表明年龄、身体质量指数(BMI)、腋窝淋巴结清扫数量、术后感染、术后规律锻炼、术后健康饮食、抑郁症史均与术后并发淋巴水肿有关(P<0.05),以此构建的风险预测模型其曲线下面积(AUC)0.791,最佳截断值0.335对应的灵敏度、特异度分别为0.698、0.772,校准曲线结果显示,平均绝对误差(MAE)为0.018,校准曲线贴合理想曲线,表示模型具有较好的校准性能,模型较为可靠稳定。结论患者行乳腺癌根治术后发生淋巴水肿受年龄、BMI、腋窝淋巴结清扫数量、术后感染等因素影响,基于各独立影响因素构建的风险预测模型预测性能良好,根据其构建康复护理模式有利于预防或减少术后淋巴水肿的发生。Objective To analyze the influencing factors of lymphedema in patients after radical surgery for breast cancer,build a risk prediction model based on independent influencing factors,and build a targeted rehabilitation nursing model.Methods To select 212 patients who underwent breast cancer radical resection in the hospital from September 2020 to August 2022 To select as the study subjects.According to whether the lymphedema occurred within 1 year after the operation,the patients were divided into 63 cases with lymphedema and 149 cases without lymphedema.The independent influencing factors were collected through univariate factor analysis and multi factor Logistic regression analysis.The risk prediction model was built based on regression analysis method.The corresponding column chart was drawn using R language software.The prediction performance was tested by Receiver Operating Curve(ROC)curve and calibration curve,and the rehabilitation and nursing model of the patients was constructed.Results After multivariate Logistic regression analysis,the results of this study showed that age,body mass index(BMI),number of axillary lymph node dissection,postoperative infection,postoperative regular exercise,postoperative healthy diet,and history of depression were all related to postoperative concurrent lymphedema(P<0.05).The risk prediction model was constructed with an Area Under Curve(AUC)of 0.791,and the sensitivity and specificity corresponding to the optimal cut-offvalue of 0.335 were 0.698 and 0.772,respectively.The calibration curve results showed that the Mean Absolute Error(MAE)was 0.018,and the calibration curve had a reasonable ideal curve,indicating that the model had good calibration performance and the model was relatively reliable and stable.Conclusion Patients with lymphedema after radical mastectomy for breast cancer were affected by age,BMI,number of axillary lymph node dissection,postoperative infection and other factors.The risk prediction model constructed based on each independent influencing factor

关 键 词：乳腺癌根治术 淋巴水肿 影响因素 康复 护理模式 

分 类 号：R473.73[医药卫生—护理学]