Developing An Arrhythmia Risk Warning Model For Post-surgery Esophageal Cancer Patients And Nursing Prevention Plan

Objectives:Arrhythmia is a common cardiovascular disease.The disease may flare up and lead to sudden death,or it may go on to affect heart function and lead to heart failure.At present,among the common postoperative complications of esophageal cancer,the incidence of arrhythmia is high,and its disease progresses rapidly,which seriously affects the prognosis of patients.This study aims to screen the influencing factors related to postoperative arrhythmia in patients with esophageal cancer,and to construct a risk warning model for postoperative arrhythmia.According to the clinical application of early warning model,high risk groups of arrhythmias after esophageal cancer surgery can be found early,and targeted nursing and prevention measures can be formulated accordingly.Methods:1.Under the guidance of risk management theory,based on a literature review and expert meeting,the questionnaire of influencing factors of postoperative arrhythmia in patients with esophageal cancer was formulated.The clinical data of180 postoperative patients with esophageal cancer who were hospitalized in the Department of Cardiothoracic Surgery,the Affiliated Hospital of Jiangnan University from December 2019 to February 2022 were retrospectively analyzed.2.According to the developed questionnaire,univariate correlation analysis was used to determine the indicators related to the early warning of postoperative arrhythmia risk,multivariate Logistic regression analysis was used to determine the independent risk factors for predicting arrhythmia,and a regression equation was formed.Receiver Operating Characteristic Curve(ROC Curve)and Area Under the Curve(AUC)were used to evaluate the discriminative power of the model.Hosmer-Lemeshow goodness-of-fit test was used to evaluate the fitting degree of the warning model.According to the established risk early warning model,153 postoperative patients with esophageal cancer who met the inclusion and exclusion criteria from February 2022 to June 2022 were selected as the validation model group to verify the effectiveness and feasibility of the early warning model.3.Based on the literature review,effective clinical guidance strategies were found based on the occurrence,existing problems,and nursing countermeasures of postoperative arrhythmia in patients with esophageal cancer,and the draft of postoperative arrhythmia nursing prevention strategy was initially constructed.An expert group meeting was organized for discussion,the first draft of the postoperative arrhythmia nursing prevention strategy was constructed,and the clinical application standard was formed.Results:1.A total of 180 patients with esophageal cancer were included in this study.The incidence of postoperative arrhythmia was 54.44%(98/180 cases).There were 28 cases of sinus tachycardia,22 cases of atrial fibrillation,6 cases of supraventricular tachycardia,4 cases of ventricular tachycardia,13 cases of ventricular premature beat,and 25 cases of atrial premature beat.The incidence was 57.14%(56/98 cases)within1 day after the operation,25.51%(25/98 cases)within 2 days after the operation,14.29%(14/98 cases)within 3 days after the operation,and 3.06%(3/98 cases)beyond 3 days after the operation.2.Multivariate Logistic regression analysis was performed to determine the related influencing factors of postoperative arrhythmia in patients with esophageal cancer.With the presence or absence of arrhythmia as the dependent variable,variables with differences in univariate analysis were defined as independent variables.The results showed that there were significant differences in preoperative heart diseases(hypertension,coronary heart disease,and diabetes),pulmonary function decline,intraoperative blood loss and postoperative hypokalemia between the two groups.These four variables are closely related to the occurrence of postoperative arrhythmia in patients with esophageal cancer.3.The partial regression coefficients of each variable in the regression equation were calculated,and the calculation formula of the risk warning model for postoperative arrhythmia in patients with esophageal cancer was constructed: P=1/{1+exp [-(0.874× preoperative heart disease +1.084× pulmonary function decline+2.974× intraoperative blood loss +3.942× postoperative hypokalemia-3.495)]}.Receiver operating characteristic(ROC)curve was used to analyze the effect of preoperative heart diseases(hypertension,coronary heart disease,and diabetes),pulmonary function decline,intraoperative blood loss and postoperative hypokalemia on postoperative arrhythmia.The Hosmer-Lemeshow fitting method was used to study the suitability of disease early warning.The early warning model was verified to judge whether the risk early warning model can be used in clinical practice.Conclusion:1.The results of this study showed that preoperative heart diseases(history of hypertension,coronary heart disease,and diabetes),pulmonary function decline,intraoperative blood loss and postoperative hypokalemia were independent risk factors for postoperative arrhythmia in patients with esophageal cancer.2.The risk prediction model of postoperative arrhythmia in patients with esophageal cancer constructed in this study has a good predictive effect.The predictors included in the model are easy to collect in clinical practice,and the model can be used to assess the risk of arrhythmia in patients with esophageal cancer after surgery,to provide a reference for clinical medical staff to prevent postoperative arrhythmia in patients and formulate intervention plans.