肝胆恶性肿瘤手术患者心理焦虑列线图预测模型的构建-现代医学

肝胆恶性肿瘤手术患者心理焦虑列线图预测模型的构建

单位：南京大学医学院附属鼓楼医院肝胆外科, 江苏南京 210008

分类号：R395.1

出版年·卷·期（页码）：2023·51·第九期（1189-1198）

摘要：

目的：调查肝胆恶性肿瘤手术患者心理焦虑影响因素，分析心理焦虑的风险指标，构建列线图模型，并对模型进行验证。方法：纳入2021年1月至2022年10月因肝胆恶性肿瘤在某三级甲等医院肝胆外科住院手术患者162例，在患者出院时进行医院焦虑抑郁量表-焦虑分量表(HADS-A) 问卷调查。依据调查问卷结果将患者分为无焦虑组(＜8分)和有焦虑组(≥8分)。采用单因素分析、Logistic多因素回归及逐步回归分析，探索影响肝胆恶性肿瘤手术患者心理焦虑的危险因素，并构建可视化列线图预测模型。结果：162例患者参与问卷调查，99例(61.1%)存在焦虑。单因素分析结果显示：住院总时长、术后住院时长、肛门排气时间、患者本人对病情知情、疼痛评分、术后24 h内睡眠时间、下床活动时间、幸福指数、积极特质应对、消极特质应对、治愈疾病的信心、自然活动减少或受限、有无感到孤独或隔离感以及减压行为在两组患者间比较，差异均有统计学意义(均P＜0.05)，上述变量纳入Logistic多因素回归模型及逐步回归模型，两模型拟合指数(AIC)分别为157.54和139.89，经比较两模型间差异无统计学意义(χ²=-12.349，P＞0.05)。逐步回归分析结果显示患者本人对病情知情、疼痛评分、幸福指数、治愈疾病的信心、减压行为为独立风险因素，这5个影响因素转换为可视化列线图预测模型后，ROC曲线分析显示，曲线下面积(AUC)为0.907(95%CI 0.861~0.953)，准确度为0.846(95%CI 0.781~0.898)，Kappa值0.684。结论：本研究构建的列线图预测模型对肝胆恶性肿瘤手术患者心理焦虑有较好的预测效能，可以帮助临床医护人员快速识别患者心理焦虑的发生风险，为及时采取预见性管理措施提供借鉴。

Objective: To investigate influence factors of psychological anxiety in patients undergoing surgery for hepatobiliary malignancies, to establish and validate a nomogram model for the prediction of anxiety. Methods: One hundred and sixty-two patients who underwent surgery for hepatobiliary malignancies in a local tertiary hospital from January 2021 to October 2022 were enrolled in this study. Hospital anxiety and depression scale-anxiety anxiety subscale(HADS-A) was used to determine the existence and severity of anxiety at the time of discharge. Patients were divided into anxiety groups(≥8) and no anxiety group(＜8) according to HADS-A score. Univariate analysis, Logistic multivariate regression and stepwise regression were used to explore the risk factors for psychological anxiety. A nomogram was established based on the results. Results: One hundred and sixty-two patients completed the subscale. Ninety-nine patients(61.1%) were found with anxiety. The results of univariate analysis showed that total length of stay, postoperative length of stay, the time to bowel movement, awareness of disease, pain score, sleeping time in the first 24 hours after surgery, off-bed time, happiness index, positive traits to respond, negative traits to respond, faith to overcome disease, reduced or limited natural activity, the feel of loneliness or isolation and stress reduction behavior were all different between two groups with statistical significance(all P<0.05). The above mentioned factors were included in Logistic multivariate regression model and stepwise regression model. The results of regression showed that fitness indexes(AIC) of the two models were 157.54 and 139.89, respectively, without statistical significance(χ²=-12.349，P＞0.05). The results of stepwise regression showed that awareness of disease, pain score, happiness index, faith to overcome disease and stress reduction behavior were independent risk factors. A nomogram was established based on these independent risk factors. Receiver operating characteristic(ROC) curve analysis showed that area under curve(AUC) was 0.907(95%CI 0.861-0.953), The accuracy rate of the model was 0.846(95%CI 0.781-0.898)and the Kappa value was 0.684. Conclusion: The nomogram established by this study has satisfying predictive efficacy for anxiety of patients undergoing surgery for hepatobiliary malignancies. The nomogram may help healthcare provider stratify the risk of anxiety in patients and provide basis of initiatives of intervention for anxiety.

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