基于随机森林的心脏外科住院患者最大舌压现状及影响因素分析  

Study on the current status and influencing factors of maximum tongue pressure in cardiac surgery inpatients based on a random forest model

作　　者：邵爱敏 朱益雷 夏海鸥[3] 仲骏 黄润[2] Shao Aimin;Zhu Yilei;Xia Haiou;Zhong Jun;Huang Run(Department of Nursing,Zhongshan Hospital,Fudan University,Shanghai 200030,China;Department of Cardiothoracic Surgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200082,China;Nursing School of Fudan University,Shanghai 200030,China)

机构地区：[1]复旦大学附属中山医院护理部,上海200030 [2]上海交通大学医学院附属新华医院心胸外科,上海200082 [3]复旦大学护理学院,上海200030

出　　处：《中国实用护理杂志》2025年第8期620-627,共8页Chinese Journal of Practical Nursing

基　　金：上海交通大学医学院附属新华医院科技基金项目(xhhlcx2023-03)。

摘　　要：目的调查心脏外科住院患者最大舌压的现状,并分析其影响因素,以为相应的高危人群个性化护理措施的制订提供依据。方法本研究为横断面调查,采用便利抽样法,选取2022年1月至2023年4月在复旦大学附属中山医院心脏外科住院患者为研究对象,采用一般资料和临床资料调查表、吞咽舌肌评估训练仪、握力计进行调查和测量,采用随机森林和LASSO回归筛选出重要影响因素,多元线性回归分析最大舌压的影响因素。结果共纳入符合纳入、排除标准的心外科住院患者501例,男308例,女193例,年龄(56.94±14.02)岁,最大舌压为(45.92±9.57)kPa。当lambda(λ)值为0.181时,模型拟合最好,对应的影响因素数目为10个,重要性排序居前10位的自变量分别为年龄、握力、性别、BMI、N末端脑钠肽前体、肾小球滤过率、心功能分级、血红蛋白、脑卒中史、房颤史。年龄、握力、低BMI、N末端脑钠肽前体、脑卒中史是心外科住院患者最大舌压的影响因素(R^(2)=0.324,F=24.92,均P<0.05)。结论护理人员应提高对心脏外科住院患者舌肌力量的关注度,对于高龄、低握力、低BMI、N末端脑钠肽前体升高、有脑卒中史的患者应及时评估其最大舌压。针对舌肌力量减弱的患者,有针对性地进行早期识别和预康复。Objective To investigate the current status of maximum tongue pressure(MTP)in cardiac surgery inpatients and analyze its influencing factors,providing a basis for developing personalized nursing measures for high-risk groups.Methods This cross-sectional study used a convenience sampling method to select cardiac surgery inpatients at Zhongshan Hospital,Fudan University,from January 2022 to April 2023.General and clinical data questionnaires,a swallowing tongue muscle evaluation training device,and a hand dynamometer were used for data collection.The random forest model and Lasso regression were employed to identify key influencing factors,and multiple linear regression was used to analyze the factors affecting MTP.Results A total of 501 cardiac surgery inpatients meeting the inclusion and exclusion criteria were enrolled,including 308 males and 193 females,with a mean age of(56.94±14.02)years.The mean MTP was(45.92±9.57)kPa.When the lambda(λ)value was 0.181,the model achieved the best fit,identifying 10 key influencing factors in descending order of importance:age,handgrip strength,gender,BMI,N-terminal pro-B-type natriuretic peptide(NT-proBNP),glomerular filtration rate,cardiac function grade,hemoglobin,history of stroke,and history of atrial fibrillation.Age,handgrip strength,low-level BMI,NT-proBNP,and history of stroke were determined as significant factors influencing MTP in cardiac surgery inpatients(R^(2)=0.324,F=24.92,P<0.05).Conclusions Nurses should pay close attention to the tongue muscle strength of cardiac surgery inpatients.Early assessment of MTP is essential for older patients,those with low handgrip strength,low BMI,elevated NT-proBNP,or a history of stroke.Targeted early identification and prerehabilitation measures should be implemented for patients with weakened tongue muscle strength.

关 键 词：心脏外科 舌 随机森林 口腔健康 吞咽障碍 预康复 老年人 握力 N末端脑钠肽前体 

分 类 号：R47[医药卫生—护理学]