以质量求发展，以服务铸品牌

护理学报 ›› 2019, Vol. 26 ›› Issue (23): 1-5.doi: 10.16460/j.issn1008-9969.2019.23.001

• 研究生园地 •    下一篇

乳腺癌术后引流管留置时间危险因素分析及风险预测模型研究

张晓璐1, 王国蓉2, 郑莹莹1, 杨璐1   

  1. 1.成都中医药大学,四川 成都 610036;
    2.四川省肿瘤医院,四川 成都 610041
  • 收稿日期:2019-07-29 发布日期:2020-07-27
  • 通讯作者: 王国蓉（1975-）,女,四川成都人,博士,主任护师,硕士研究生导师。
  • 作者简介:张晓璐（1996-）,女,四川成都人,本科学历,硕士研究生在读。

Risk Factors and Risk Prediction Model of Drainage Tube Indwelling Time after Breast Cancer Surgery

ZHANG Xiao-lu1, WANG Guo-rong2, ZHENG Ying-ying1, YANG Lu1   

  1. 1. Chengdu University of Chinese Medicine, Chengdu 610036, China;
    2. Sichuan Cancer Hospital and Institution, Chengdu 610041, China
  • Received:2019-07-29 Published:2020-07-27

PDF (PC)

132

赞

摘要： 目的 探究影响乳腺癌患者术后引流管留置时间的危险因素并建立风险预测模型。方法 收集某三级甲等医院2018年5月—2019年4月200例在全麻下实施乳腺癌手术的患者的基本临床资料,采用单因素分析及Logistic 回归分析筛选出影响乳腺癌术后引流管留置的危险因素,建立Logistic回归预测模型,用Hosmer and Lemeshow 检验来对所建立的预测模型的拟合优度进行测验,应用ROC曲线下面积来检验模型的预测效果。结果 多因素Logistic 回归分析结果表明BMI（OR=1.337）、乳腺癌手术方式（OR=4.527）、腋窝淋巴结手术方式（OR=3.483）、负压引流方式（OR=4.518）、基础疾病（OR=6.170）、并发症（OR=2.846）均是影响乳腺癌术后引流管留置的危险因素。Hosmer and Lemeshow 检验提示预测模型拟合度为（χ2=10.539,P=0.229）;ROC 曲线下面积（AUC）为0.842,敏感性为0.815,特异性为0.750,Youden指数最大值为0.565。结论 BMI、乳腺癌手术方式、腋窝淋巴结手术方式、一次性负压引流方式、基础疾病、并发症均为影响患者术后引流管留置时间的独立危险因素。本研究所建立的预测模型价值较高,可为临床做好乳腺癌患者术后引流管留置时间的管理提供参考。

关键词: 乳腺癌, 引流管留置时间, 危险因素, 风险预测

Abstract: Objective To explore the risk factors affecting postoperative indwelling time of drainage tube of breast cancer patients and establish a risk prediction model. Methods We collected basic clinical data of 200 patients undergoing breast cancer surgery under general anesthesia from May 2018 to April 2019 in a tertiary grade-A hospital. Univariate analysis and logistic regression analysis were used to screen out the risk factors affecting postoperative indwelling time of drainage tube, and a logistic regression prediction model was established. The Hosmer and Lemeshow test was used to test the goodness of fit of the established prediction model, and the area under the ROC curve was used to test the prediction effect of the model. Results Multivariate logistic regression analysis showed BMI (OR=1.337), breast cancer surgical method (OR=4.527), axillary lymph node surgical method (OR=3.483), negative pressure drainage (OR=4.518), underlying disease (OR=6.170) and complications (OR=2.846) were risk factors for the retention of drainage tube after breast cancer surgery. The Hosmer and Lemeshow test indicated that the model fit was (χ2=10.539, P=0.229). The area under the ROC curve (AUC) was 0.842 with a sensitivity of 0.815 and a specificity of 0.750, and the Youden index was 0.565. Conclusion BMI, breast cancer surgical method, axillary lymph node surgical method, one-time negative pressure drainage, basic diseases and complications are independent risk factors for the indwelling time of patients with postoperative drainage. The predictive model established in this study has a high value, which provides reference for the management of postoperative drainage tube retention time in breast cancer patients.

Key words: breast cancer, drainage tube indwelling time, risk factor, risk prediction

中图分类号: 

  • R473.6
[1] Zhao J, Su F, Hu Y,et al.Prospective Comparison of Sapylin and Avitene for Reducing Hydrops after Axillary Lymphadenectomy in Breast Cancer Patients[J]. J Surg Res, 2017, 210:8-14.DOI:10.1016/j.jss2016.10.032.
[2] 张婷. 乳腺癌术后皮下积液影响因素分析[D].杭州:浙江大学, 2017.
[3] Susini T, Renda I, Giani M,et al.Changing Trends in Mastectomy and Breast Reconstruction. Analysis of a Single-institution Experience Between 2004-2016[J].Anticancer Res, 2019, 39(10):5709-5714.DOI:10.21873/anticanres.13770.
[4] 袁慧蓉,梁英,程娜. 60例乳腺癌术后患者康复训练护理实践[J].护理学报,2018, 25(2):67-69. DOI:10.16460/j.ssn1008-9969.2018.02.067.
[5] Elsarrag M, Soldozy S, Patel P, et al.Enhanced Recovery after Surgery (ERAS) for Spine Surgery: A Systematic Review[J]. Neurosurg Focus,2019,46(4):415-426.DOI:10.3171/2019.1.FOCUS18700.
[6] 张蕊,郑黎强, 国伟. 疾病发病风险预测模型的应用与建立[J].中国卫生统计,2015, 32(4):724-726.
[7] 韩树坤. 乳腺癌改良根治术术后引流管拔管时间的选择[J].中国实用医药,2018,13(26):45-46. DOI:10.14163/j.cnki.11-5547/r.2018.26.022.
[8] 陈澎涛. 乳腺癌术后引流时间的影响因素分析[J]. 上海医药,2017,38(15):48-49.DOI:10.3969/J.ISSN.1006-1533.2017.15.012.
[9] 杨丽丽,马淑云,王莉. 乳腺癌患者术后切口引流管留置时间的影响因素及护理对策[J].实用临床医药杂志,2016, 20(12):170-172.DOI:10.7619/jcmp.201612058.
[10] Evans DGR, Harkness, Brentnall AR, et al.Breast Cancer Pathology and Stage are Better Predicted by Risk Stratification Models That Include Mammographic Density and Common Genetic Variants[J]. Breast Cancer Res Treat, 2019, 176(1):141-148. DOI:10.1007/s10549-019-05210-2.
[11] Lee C P, Choi H, Soo K C S, et al. Mammographic Breast Density and Common Genetic Variants in Breast Cancer Risk Prediction[J]. PLoS ONE,2015, 10(9):e0136650. DOI: 10.1371 /journal. pone. 0136650.
[12] Gencay Can A, Cakci F A, et al.Early Detection and Treatment of Subclinical Lymphedema in Patients with Breast Cancer[J]. Lymphat Res Biol, 2019, 17(3):368-373. DOI:10.1089/Lrb. 2018.0033.
[13] Vos H, Smeets A,Neven P, et al.Early Drain Removal Improves Quality of Life and Clinical Outcomes in Patients with Breast Cancer-results from a Randomised Controlled Trial[J]. Eur J Oncol Nurs, 2018,36,112-118. DOI:10.1016/J.EJON.2018.08.007.
[14] Liu F X, Flatt S W, Pakiz B, et al.Physical Activity Levels of Overweight or Obese Breast Cancer Survivors: Correlates at Entry Into a Weight Loss Intervention Study[J]. Support Care Cancer,2016, 24(1):173-180. DOI:10.1007/s00520-015-2761-2.
[15] 游文锋. 超声刀与普通电刀在乳腺癌腋窝淋巴结清扫术中的应用[J].临床医学,2017, 37(9):52-54.DOI:10.3969/j.issn.1005-6483.2015.05.017.
[16] 刘新义,奚凯雯,陈允允. 乳腺癌病人辅助治疗期间体重变化研究进展[J]. 护理研究, 2019, 33(13):2267-2271.DOI:10.12102/J.ISSN.1009-6493.2019.13.018.
[17] 陈立芳,王颖. 中心负压吸引及创面注入沙培林预防乳腺癌术后皮下积液的效果研究[J]. 护理学报, 2017, 24(16):41-42.DOI:10.16460/J.ISSN1008-9969.2017.16.041.
[18] Maskarinec G, Aspelund T, Harris T B, et al.Type 2 Diabetes and Obesity in Midlife and Breast Cancer Risk in the Reykjavik Cohort[J]. Cancer Causes Control, 2019, 30(10): 1057-1065. DOI:10. 1007/s10552-019-01213-y.
[19] Huang B Z, Camp M S, et al.Burden of Preoperative Cardiovascular Disease Risk Factors on Breast Cancer Surgery Outcomes[J].J Surg Oncol, 2016, 114(2):144-149. DOI: 10.1002/jso.24298.
[20] 陈钦羡. 乳腺癌合并高血压糖尿病术后皮下积液的预防措施与临床护理对策研究[J]. 糖尿病新世界, 2017, 20(10):147-148.DOI:10.16658/j.cnki.1672-4062.2017.10.147.
[21] 李敏,耿晓莉. 压力传感器在乳腺癌改良根治术后皮下积液预防中的应用效果观察[J]. 护理研究, 2019, 33(13): 2356-2358. DOI:10.12102/j.issn.1009-6493.2019.13.044.
[22] 黄海涛,李灵,冯俊. 乳腺癌术后切口感染病原菌分布与耐药性分析[J]. 中华医院感染学杂志, 2014, 24(15): 3671-3673. DOI:10.11816/cn.ni.2014-133451.
[23] 徐明月,王湘红,颜灵松. 乳腺癌根治术患者切口感染的影响因素及病原学特点分析[J].中华医院感染学杂志,2019, 29(9):1400-1403. DOI:10.11816/cn.ni.2019-181158.
[1] 郑小静, 严红虹, 李慧景, 陈思涓, 陈秀梅. 肝细胞癌伴低血糖症风险预测模型的构建与验证[J]. 护理学报, 2025, 32(4): 53-58.
[2] 李雪, 廖常菊, 张健, 丁娟, 陈晓丽, 胡玉庭. 三级甲等医院ICU护士睡眠障碍的风险预测模型构建及验证[J]. 护理学报, 2025, 32(2): 63-69.
[3] 华晶, 张青月, 王燕, 程畅, 张秀丽, 张爱爱. 问题提示清单在乳腺癌手术患者中的应用研究[J]. 护理学报, 2024, 31(8): 18-22.
[4] 曹娟, 李方, 于跃, 戴丽, 杨丹丹, 李志华, 徐欣怡, 戴琪, 陈柯宇. 食管癌术后静脉血栓栓塞症风险预测模型的构建及验证[J]. 护理学报, 2024, 31(8): 63-68.
[5] 周越, 张杰, 潘宇帆, 戴雨, 孙羽健, 肖益, 余雨枫. 机械通气患者衰弱风险预测模型的系统评价[J]. 护理学报, 2024, 31(6): 56-61.
[6] 李佳萍, 朱云霞, 朱宇. 乳腺癌化疗患者症状群的范围综述[J]. 护理学报, 2024, 31(4): 60-64.
[7] 邢春凤, 李国新, 张广清, 刘雅鑫, 孙晓伟. 产妇产褥期乳房胀痛危险因素分析及风险预测模型构建[J]. 护理学报, 2024, 31(3): 6-11.
[8] 王丽云, 张明慧, 张新月, 沙凯辉. 产后压力性尿失禁风险预测模型的系统评价[J]. 护理学报, 2024, 31(3): 57-62.
[9] 赵国瑞, 刘高明, 张凤, 周颖. 宫颈癌患者术后下肢淋巴水肿风险预测模型的构建及验证[J]. 护理学报, 2024, 31(24): 7-12.
[10] 姚婉晴, 杨立状, 陈旦旦, 张晚秋, 卢薇, 管翠红, 李海. 不同非药物干预措施改善乳腺癌患者疲乏效果的网状Meta分析[J]. 护理学报, 2024, 31(24): 37-43.
[11] 李苗, 李红梅, 张俊, 李盼盼, 张宇彤, 王茜, 李沁瑶. 乳腺癌化疗患者自我倡权潜在类别及影响因素分析[J]. 护理学报, 2024, 31(20): 19-23.
[12] 胡宁宁, 李玉凤, 王仁媛, 李婉君, 林素兰. 学龄前儿童超重肥胖现状及影响因素分析[J]. 护理学报, 2024, 31(2): 16-21.
[13] 戴美芬, 梁钰贞, 杨静, 尤燕燕, 杨清, 昌广婷, 区幸莹, 黄传蔷, 陈智星, 区洁芬. 基于循证和中医理念的乳腺癌化疗患者癌因性疲乏护理干预方案的构建[J]. 护理学报, 2024, 31(15): 34-38.
[14] 邬馨益, 徐林燕, 陈卓琦, 朱徐乐, 赵磊. 老年人运动认知功能减退综合征风险预测模型的构建与验证[J]. 护理学报, 2024, 31(10): 73-78.
[15] 史婷婷, 李婷, 黄友鹏, 赵媛, 朱晓丽, 周梦娟, 陈云梅. 2型糖尿病患者合并骨质疏松风险预测模型的范围综述[J]. 护理学报, 2024, 31(1): 52-57.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!