消化内镜检查前患者焦虑影响因素分析及预测模型建立

Influencing factors of anxiety in patients before digestive endoscopy examinations and construction of prediction model

目的分析消化内镜检查前患者焦虑的影响因素,并构建预测模型。方法选取218例行消化内镜检查的患者为研究对象,收集患者的一般资料,采用焦虑自评量表、社会支持评定量表、家庭关怀度指数问卷评估患者的焦虑情况、社会支持度和家庭关怀度。采用多因素Logistic回归分析探讨消化内镜检查前患者焦虑的影响因素,并构建预测模型,进行Hosmer-Lemeshow拟合优度检验;采用受试者工作特征(ROC)曲线分析预测模型的灵敏度和特异度。另选取接受消化内镜检查的45例患者进行临床验证,分析预测模型与临床实际的一致性。结果根据消化内镜检查前患者是否发生焦虑情况,分为焦虑组94例和无焦虑组124例,患者焦虑的发生率为43.12%(94/218)。消化内镜检查前患者在性别、文化程度、婚姻状况、既往检查史、麻醉方式、医疗支付方式、社会支持度、家庭关怀度方面均有显著差异(P<0.05或0.01)。多因素Logistic回归分析显示女性、无既往检查史、非全麻、社会支持度低是导致消化内镜检查前患者焦虑的危险因素(P<0.05或0.01)。预测模型为:P=e^(X)/(1+e^(X)),X=-5.968+1.404×女性+1.652×无既往检查史+1.207×非全麻+0.664×社会支持度低。ROC曲线下面积为0.761(95%CI=0.696~0.826,P=0.000),灵敏度为69.15%,特异度为70.16%。Hosmer-Lemeshow拟合优度检验显示χ^(2)=13.489,P=0.096,提示模型的拟合水平较好。临床验证该模型的准确率为84.44%,一致性检验Kappa值为0.688,具有较高的一致性。结论影响消化内镜检查前患者焦虑的因素较多,研究构建的预测模型准确率较高,具有一定的指导意义,可为临床实施针对性心理干预缓解患者内镜检查前焦虑提供参考。

Objective To analyze the influencing factors of anxiety in patients before digestive endoscopy examinations and construct the prediction model.Methods A total of 218 patients undergoing digestive endoscopy examinations were selected as research objects,their general data collected,and Selfrating Anxiety Scale(SAS),Social Support Rating Scale(SSRS)and Family Adaptation,Partnership,Growth,Affection,and Resolve(APGAR)used to assess patients'anxiety level,social support and family caring degree.Multiva riate Logistic regression a nalysis was used to explore the influencing factors of anxiety in patients before digestive endoscopy examination,the prediction model constructed,and Hosmer-Lemeshow good ness-of-fit test performed;the receiver operating characteristic(ROC)curve was used to evaluate the sensitivity and specificity of the prediction model.Another 45 patients undergoing digestive endoscopy examinations were selected for clinical validation to analyze the consistency between the prediction model and clinical practice.Results The patients were divided into anxiety(n=94)and non-anxiety(n=124)group according to whether they had anxiety before digestive endoscopy examinations,the incidence of anxiety in this study was 43.12%(94/218).There were significant differences interm of gender,educational level,marital status,past examination history,anesthesia method,medical payment method,social support,and family caring degree before digestive endoscopy examinations(P<0.05 or 0.01).Multivariate Logistic regression analysis found that female,no preliolls examination history,non general anesthesia,and low social support were risk factors for anxiety before digestive endoscopy examinations(P<0.05 or 0.01).The prediction model was:P=e^(X)/(1+e^(X)),X=-5.968+1.404×female+1.652×first-time examination+1.207×non general anesthesia+0.664×low social support.The area under the ROC curve was 0.761(95%CI=0.696~0.826,P=0.000),sensitivity 69.15%,and specificity 70.16%.Hosmer-Lemeshow goodness-of-fit test showedχ^(2)=13.489 and P=0.096,indicating that the model had good goodness-offit.Clinical validation showed that the accuracy of the model was 84.44%,Kappa value of consistency check 0.688,and which had a high consistency.Conclusion Factors influencing anxiety in patients before digestive endoscopy examinations are numerous,the accuracy of prediction model constructed in the study is higher,which has certain guiding significance,and can provide reference for clinical implementation of targeted psychological intervention to alleviate patients'anxiety before endoscopy.