乳腺癌手术患者上肢功能障碍危险因素分析及风险模型构建

Risk factor analysis and construction of risk model for upper limb dysfunction in breast cancer surgery patients

目的:分析乳腺癌手术患者发生上肢功能障碍的危险因素,构建影响上肢功能障碍的危险因素风险模型并验证其性能。方法:2021年2月至2022年2月选取350例已行乳腺癌改良根治术2~5个月的女性患者进行非匹配的病例对照研究。经过Rowe肩关节评估量表评定,将评分<75分者作为病例组,评分≥75分者作为对照组。采用Logistic统计分析乳腺癌手术患者上肢功能障碍的危险因素,构建列线图风险预测模型并进行内部验证。结果:大学及以上文化水平、满意夫妻关系、高水平自我效能是乳腺癌手术患者上肢功能障碍的保护因素(P<0.05);年龄65~80岁、伤口痛、失眠、极少主动运动上肢、非常恐惧运动、复发乳腺癌、从不渴望娱乐活动、一点也不和朋友亲近是乳腺癌手术患者上肢功能障碍的危险因素(P<0.05)。将以上因素纳入并构建列线图风险预测模型,结果显示,伤口疼痛、夫妻关系、失眠、主动运动上肢等可干预因素对乳腺癌手术患者上肢功能障碍发生风险影响较大。内部验证结果显示模型的ROC曲线下面积为0.858。校正曲线表明列线图预测出的乳腺癌上肢功能障碍发生风险和实际发生风险之间有较好的一致性,校正后C指数为0.837。结论:构建的乳腺癌手术患者上肢功能障碍的危险因素风险模型的预测效果较好,可以辅助临床医护人员筛选影响上肢功能障碍的高风险因素,尤其是可干预的疼痛症状、失眠症状、主动运动行为及夫妻关系等,采取早期应对措施,促进术后康复。

Objective:To analyze the risk factors of upper limb dysfunction in breast cancer surgery patients,to construct the risk model of the risk factors affecting upper limb dysfunction and to verify its performance.Methods:From February 2021 to February 2022,350 women who had passed 2 to 5 months after modified radical breast cancer surgery were selected for an unmatched case-control study.After assessment by Rowes rating System for Bankart repair,those with a score of<75 points were as the case group and those with a score of≥75 points were as the control group.Logistic statistical analysis was used to analyze the risk factors of upper limb dysfunction in breast cancer surgery patients,to construct the nomogram risk prediction model and to verify it internally.Results:University degree or above,satisfactory marital relationship and high level of self-efficacy were protective factors for upper limb dysfunction in breast cancer surgery patients(P<0.05).Aged 65 to 80 years,wound pain,insomnia,rarely active upper limb exercise,very fear of exercise,recurrence of breast cancer,no desire for recreational activities,and not being close to friends were the risk factors for upper limb dysfunction of breast cancer surgery patients(P<0.05).The above factors were included and the nomogram risk prediction model was built.The results showed that intervention factors such as wound pain,marital relationship,insomnia and active upper limb movement had a great impact on the risks of upper limb dysfunction in breast cancer surgery patients.Internal verification results showed that the area under the ROC curve of the model was 0.858.The calibration curve showed a good consistency between the risks of breast cancer upper limb dysfunction predicted by the nomogram and the actual risks,and the C index was 0.837 after correction.Conclusion:The constructed risk model of risk factors for upper limb dysfunction in patients with breast cancer surgery has a good prediction effect.It can assist clinical medical and nursing staff to screen high risk factors affecting upper limb dysfunction,especially pain symptoms,insomnia symptoms,active movement behavior,marital relationship and other factors that can be intervened.This allows for early response measures and postoperative rehabilitation.