摘要
目的 探讨意外妊娠终止女性创伤后应激障碍(post-traumatic stress disorder,PTSD)的影响因素,基于独立影响因素构建并验证风险预测模型。方法 选取2022年6月-2024年2月在医院住院意外妊娠终止的女性患者180例,根据患者妊娠终止后1个月内有无检出PTSD阳性分为PTSD组(n=44)和无PTSD组(n=136),通过单因素分析及多因素Logistic回归分析得出独立影响因素,并基于回归分析法构建预测模型,使用R语言软件绘制对应的列线图,采用患者工作特征(Receiver operating characteristic,ROC)曲线、校准曲线检验模型的预测效能。另选取2024年3—8月就诊的78例患者作为外部验证集,采用验证集数据绘制ROC及校准曲线对模型的预测效能进行外部验证。结果 多因素Logistic回归分析结果显示,性格类型、职业状态、妊娠终止方式、初感胎动、抑郁、焦虑、心理弹性、生育问题均是发生PTSD的独立影响因素,差异有统计学意义(P<0.05),基于以上8个独立影响因素构建的风险预测模型其建模集的曲线下面积(area under curve,AUC)为0.872(95%置信区间为0.814~0.940,P<0.001),分值临界值为0.203,灵敏度为0.886,特异度为0.750,模型具有较好的区分能力。校准曲线的平均绝对误差(mean absolute error,MAE)为0.020,与45°的理想线部分重合,系统性误差较少。外部验证的AUC和MAE结果良好,提示模型具有较好的外部预测效能。结论 意外妊娠终止女性患者发生PTSD受性格类型、妊娠情况、心理健康等因素影响,基于这些因素构建的风险预测模型具有较好的预测效能,可帮助临床上筛选PTSD风险高的女性,提前采取心理护理措施,确保意外妊娠终止女性心理健康。
Objective To explore the influencing factors of post-traumatic stress disorder(PTSD)in women following unintended pregnancy termination,and to construct and validate a risk prediction model based on independent influencing factors.Methods A total of 180 female patients who were hospitalized for unintended pregnancy termination between June 2022 and February 2024 were selected.They were divided into a PTSD group(n=44)and a non-PTSD group(n=136)according to whether PTSD was detected within one month after pregnancy termination.Univariate analysis and multivariate Logistic regression analysis were used to identify independent influencing factors.A prediction model was constructed based on the regression analysis method.The corresponding nomogram was drawn using R language software,and the receiver operating characteristic(ROC)curve and calibration curve were used to test the predictive performance of the model.In addition,78 patients who visited the hospital from March to August 2024 were selected as an external validation set.ROC and calibration curves were drawn using the validation set data to externally validate the predictive performance of the model.Results Multivariate Logistic regression analysis showed that the personality type,occupational status,method of pregnancy termination,first feeling of fetal movement,depression,anxiety,psychological resilience,and fertility problems were all independent influencing factors for developing PTSD,with statistically significant differences(P<0.05).The risk prediction model constructed based on the above eight independent influencing factors had an area under the curve(AUC)of 0.872(95%confidence interval:0.814-0.940,P<0.001)in the modeling set,a critical value of 0.203,a sensitivity of 0.886,and a specificity of 0.750,indicating that the model had good discriminatory ability.The mean absolute error(MAE)of the calibration curve was 0.020,partially overlapping with the ideal 45°line,indicating minimal systematic error.External validation showed good AUC and MAE results,suggesting that the model has good external predictive performance.Conclusion The occurrence of PTSD in female patients who experience unintended pregnancy termination is affected by factors such as personality type,pregnancy status,and mental health.The risk prediction model constructed based on these factors has good predictive performance.It can help clinically identify women at high risk of PTSD,and take psychological care measures in advance to ensure the mental health of women following unintended pregnancy termination.
作者
赖凤萍
赖侦美
陈亨堋
肖艳芳
毛露
LAI Fengping;LAI Zhenmei;CHEN Hengpeng;XIAO Yanfang;MAO Lu(Ganzhou People's Hospital,Ganzhou 341000,China)
出处
《护理实践与研究》
2025年第10期1474-1481,共8页
Nursing Practice and Research
基金
江西省卫生健康委科技计划(编号:202410860)。
关键词
意外妊娠终止
女性
创伤后应激障碍
风险预测模型
影响因素
Unintended pregnancy termination
Female
Post-traumatic stress disorder
Risk prediction model
Influencing factors
