基于LASSO-Logistic回归构建胸腔镜术后患者生活质量影响因素的预测模型-现代医学

基于LASSO-Logistic回归构建胸腔镜术后患者生活质量影响因素的预测模型

单位：南京医科大学附属脑科医院胸外科, 江苏南京 210029

分类号：R473.6

出版年·卷·期（页码）：2024·52·第一期（149-158）

摘要：

目的：探讨快速康复护理理念干预对肺癌患者胸腔镜术后生活质量的影响，构建风险预测模型并进行验证。方法：选取2022年1月—11月于南京市某综合三甲医院胸外科收治的141例肺癌胸腔镜术后患者为研究对象。对研究对象开展快速康复外科理念护理干预，并收集其术后睡眠质量、疼痛、焦虑和抑郁相关指标评分。结果：基于LASSO回归筛选变量和多因素Logistic回归分析，结果显示术前预康复护理时长(腹式呼吸、缩唇呼吸、咳嗽训练、心理支持和健康宣教)、术后肺康复护理护理时长(腹式呼吸、深呼吸、主动呼吸循环技术和正确咳嗽)和早期床旁活动护理时长(抬高床头、坐位、床旁坐位、步行训练、主动关节活动和健康宣教)为肺癌患者胸腔镜术后疼痛、焦虑、抑郁和睡眠质量下降的影响因素(P<0.05)。列线图提示正确咳嗽、腹式呼吸和术前腹式呼吸护理干预对胸腔镜术后疼痛、焦虑、抑郁和睡眠质量下降发生影响较大。ROC曲线下面积分别为0.731[95%CI(0.546~0.916)]、0.865[95%CI(0.789~0.940)]、0.800[95%CI(0.691~0.909)]和0.865[95%CI(0.776~0.921)]。Bootstrap对上述模型进行内部验证，发现预测模型较稳定。结论：本研究构建的预测模型效能良好，提示快速康复护理理念干预可有效地改善患者术后疼痛、焦虑抑郁和睡眠质量下降的发生风险。

Objective: To explore the effects of enhanced recovery after surgery nursing intervention on the quality of life of lung cancer patients after thoracoscopic surgery, and to construct and verify a risk prediction model. Methods: A total of 141 lung cancer patients underwent single-port thoracoscopic surgery in the Department of Thoracic Surgery in a tertiary level-A general hospital in Nanjing from January to November 2022. All subjects carried out the nursing interventions of enhanced recovery after surgery. Scores of sleep quality, pain, anxiety, and depression were collected. Results: Based on multiple linear regression model, the results showed that preoperative pre-rehabilitation nursing duration(abdominal breathing, lip girdle expiration, cough training, psychological support and health education), postoperative pulmonary rehabilitation nursing duration(abdominal breathing, deep breathing, ACBT and correct cough), and early bedside activity nursing duration(raised head, sitting position, bedside sitting position, walking training, active joint movement and health education) had statistically significant effects on thoracoscopic postoperative symptoms of lung cancer patients. The nomogram suggested that correct cough, abdominal breathing, and preoperative abdominal breathing nursing intervention significantly affected pain, anxiety, depression, and decreased sleep quality after thoracoscopic surgery. The area under the ROC curve was 0.731(95%CI:0.546-0.916), 0.865(95%CI:0.789-0.940), 0.800(95%CI:0.691-0.909) and 0.865(95%CI:0.776-0.921), respectively. Bootstrap internal validation of the above models showed that the prediction model was relatively stable. Conclusions： The predictive models constructed in this study are efficient, suggesting that rapid rehabilitation care concept interventions can effectively improve patients' risk of post-operative pain, anxiety, depression, and decreased sleep quality.

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