摘要
目的探讨Munro与Waterlow压疮危险评估量表在神经外科手术患者压疮预测中的效果。方法选取2018年2-4月我院神经外科手术患者102例,由2名评估者分别采用两种量表在术前(术前1 d访视患者时)、术中(皮肤缝合结束后)及术后(患者返回病室后2 h)3个时间段内评估患者压疮发生的风险程度,同时由第3名评估者在术前、术中及术后24 h、48 h、72 h进行全身皮肤的检查,评估患者压疮发生情况并记录。结果 Munro与Waterlow量表的Cronbach′sα系数分别为0.841和0.631;Munro及Waterlow量表的ROC曲线下面积(AUC)分别为术前:0.715、0.613;术中:0.809、0.615;术后:0.849、0.598。在预测效果中,Munro量表对手术压疮的诊断价值较高,但两种量表在推荐临界值时特异度均不理想,分析Munro及Waterlow量表在不同手术阶段的最佳临界值分别为术前9分、9分;术中20分、16分;术后25分、17分。结论 Munro量表的内部一致性信度高于Waterlow量表;还需进一步扩大样本量,修订Munro量表的诊断临界值,寻求适合神经外科手术患者更加科学和有效的压疮评估工具。
Objective To compare the applying effect of Munro scale and Waterlow scale in predicting pressure ulcers in neurosurgery surgical patients. Method 102 cases of neurosurgical patients in tertiary hospital were randomly selected. Two scales were assessed and documented by two staffs separately before surgery(visiting the patient on the day before surgery), during surgery(after skin sutured)and after surgery(2 h after the patient return to ward). At the same time, the third staff performed a whole-body skin examination before surgery, during surgery, and 24 h, 48 h, and 72 h after surgery to assess the occurrence of pressure ulcers and recorded. Results The Cronbach's α coefficient of the Munro evaluation scale and Waterlow scale were 0.841 and 0.631 respectively; The AUC of Munro and Waterlow scale were 0.715 and 0.613 respectively; Intraoperative were 0.809, 0.615; Postoperative were 0.849, 0.598. Conclusion Munro scale has higher internal consistency reliability than Waterlow scale; Munro scale has higher diagnostic value for surgical pressure sores, however, the specificity of the two scales is not ideal at the recommended threshold. The optimal thresholds for analyzing the Munro and Waterlow scale at different surgical stages are preoperative 9 points, 9 points; Intraoperative scores were 20 points, 16 points, and post-operative scores were 25 points and 17 points. The results suggested that more samples are needed for further investigation to revise the diagnostic threshold of Munro scale, and to find more scientific tools of pressure sore assessment for neurosurgical patients.
引文
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