Norton量表对ICU低温体外循环心脏外科术后患者压力性损伤的预测价值及护理策略
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摘要
目的分析Norton量表对ICU低温体外循环心脏外科术后患者压力性损伤的预测价值及护理策略。方法选取2017年在新疆医科大学第一附属医院行低温体外循环心脏外科手术并转入ICU的患者322例,根据压力性损伤发生情况分为压力性损伤组108例和非压力性损伤组214例。比较两组患者Norton量表总分及各项评分;Norton量表各项评分与ICU低温体外循环心脏外科术后患者压力性损伤的关系分析采用多因素Logistic回归分析;结合预试验数据计算Cronbach'sα系数以评价Norton量表的信度;绘制ROC曲线以评价Norton量表总分对ICU低温体外循环心脏外科术后患者压力性损伤的预测价值。结果 (1)两组患者Norton量表评分比较,差异无统计学意义(P>0.05)。两组患者身体状况、活动能力、失禁情况评分比较,差异无统计学意义(P>0.05);压力性损伤组患者精神状况、移动能力评分低于非压力性损伤组(P<0.05)。(2)多因素Logistic回归分析结果显示,Norton量表移动能力评分是ICU低温体外循环心脏外科术后患者压力性损伤的独立影响因素〔OR=1.776,95%CI(1.071,2.946),P<0.05〕。(3)预试验结果显示,Norton量表的Cronbach'sα系数为0.538。(4)绘制ROC曲线发现,Norton量表总分预测ICU低温体外循环心脏外科术后患者压力性损伤的曲线下面积(AUC)为0.413〔95%CI(0.349,0.476)〕,最佳截断值为15.5分,灵敏度为69.4%,特异度为24.8%。结论 ICU低温体外循环心脏外科术后患者压力性损伤发生率较高,但Norton量表对此类患者压力性损伤的信度、预测价值较低,需结合其他量表以有效评估压力性损伤发生风险及指导护理策略的制定。
Objective To analyze the predictive value of Norton scale on pressure injury in postoperative patients treated by cardiac surgery under cryogenic cardiopulmonary bypass in ICU and the nursing strategy. Methods In 2017,a total of 322 postoperative patients treated by cardiac surgery under cryogenic cardiopulmonary bypass were selected in ICU,the First Affiliated Hospital of Xinjiang Medical University,and they were divided into A group(complicated with pressure injury,n=108)and B group(did not complicate with pressure injury,n=214)according to the incidence of pressure injury.Total Norton scale score and each dimension score of Norton scale were compared between the two groups;multivariate Logistic regression analysis was used to analyze the relationship between each dimension score of Norton scale and pressure injury in postoperative patients treated by cryogenic cardiopulmonary bypass cardiac surgery in ICU;Cronbach's α coefficient was calculated to evaluate the reliability of Norton scale according to the pre-experimental data;ROC curve was drawn to evaluate the predictive value of total Norton scale score on pressure injury in postoperative patients treated by cryogenic cardiopulmonary bypass cardiac surgery in ICU. Results(1)No statistically significant difference of total Norton scale score was found between the two groups(P>0.05). No statistically significant difference of physical condition score,capacity for action score or incontinence status score was found between the two groups(P>0.05);mental condition score and moving ability score in A group were statistically significantly lower than those in B group(P<0.05).(2)Multivariate Logistic regression analysis results showed that,moving ability score of Norton scale was the independent influencing factor of pressure injury in postoperative patients treated by cryogenic cardiopulmonary bypass cardiac surgery in ICU〔OR=1.776,95%CI(1.071,2.946),P<0.05〕.(3)Pre-experimental results showed that,the Cronbach's α coefficient of Norton scale was 0.538.(4)ROC curve showed that,AUC of total Norton scale score in predicting pressure injury was 0.413〔95%CI(0.349,0.476)〕in postoperative patients treated by cryogenic cardiopulmonary bypass cardiac surgery in ICU,the optimum cut-off value was15.5 score,the sensitivity was 69.4%,the specificity was 24.8%. Conclusion Incidence of pressure injury is relatively high in postoperative patients treated by cardiac surgery under cryogenic cardiopulmonary bypass in ICU,but the reliability and predictive value of Norton scale is relatively low in above patients,thus we should combined with other scales to effectively evaluate the risk of pressure injury and guide the formulation of nursing strategy.
Objective To analyze the predictive value of Norton scale on pressure injury in postoperative patients treated by cardiac surgery under cryogenic cardiopulmonary bypass in ICU and the nursing strategy. Methods In 2017,a total of 322 postoperative patients treated by cardiac surgery under cryogenic cardiopulmonary bypass were selected in ICU,the First Affiliated Hospital of Xinjiang Medical University,and they were divided into A group(complicated with pressure injury,n=108)and B group(did not complicate with pressure injury,n=214)according to the incidence of pressure injury.Total Norton scale score and each dimension score of Norton scale were compared between the two groups;multivariate Logistic regression analysis was used to analyze the relationship between each dimension score of Norton scale and pressure injury in postoperative patients treated by cryogenic cardiopulmonary bypass cardiac surgery in ICU;Cronbach's α coefficient was calculated to evaluate the reliability of Norton scale according to the pre-experimental data;ROC curve was drawn to evaluate the predictive value of total Norton scale score on pressure injury in postoperative patients treated by cryogenic cardiopulmonary bypass cardiac surgery in ICU. Results(1)No statistically significant difference of total Norton scale score was found between the two groups(P>0.05). No statistically significant difference of physical condition score,capacity for action score or incontinence status score was found between the two groups(P>0.05);mental condition score and moving ability score in A group were statistically significantly lower than those in B group(P<0.05).(2)Multivariate Logistic regression analysis results showed that,moving ability score of Norton scale was the independent influencing factor of pressure injury in postoperative patients treated by cryogenic cardiopulmonary bypass cardiac surgery in ICU〔OR=1.776,95%CI(1.071,2.946),P<0.05〕.(3)Pre-experimental results showed that,the Cronbach's α coefficient of Norton scale was 0.538.(4)ROC curve showed that,AUC of total Norton scale score in predicting pressure injury was 0.413〔95%CI(0.349,0.476)〕in postoperative patients treated by cryogenic cardiopulmonary bypass cardiac surgery in ICU,the optimum cut-off value was15.5 score,the sensitivity was 69.4%,the specificity was 24.8%. Conclusion Incidence of pressure injury is relatively high in postoperative patients treated by cardiac surgery under cryogenic cardiopulmonary bypass in ICU,but the reliability and predictive value of Norton scale is relatively low in above patients,thus we should combined with other scales to effectively evaluate the risk of pressure injury and guide the formulation of nursing strategy.
引文
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[12]于彬彬,宁华秀,陈晓琳.Norton量表对老年患者全髋关节置换术后并发症预测效果的前瞻性研究[J].中国实用护理杂志,2017,33(35):2734-2737.DOI:10.3760/cma.j.issn.1672-7088.2017.35.004.
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[14]何侃侃,姚金兰.成人压疮风险评估量表在病人围术期的应用进展[J].全科护理,2016,14(36):3799-3801.DOI:10.3969/j.issn.1674-4748.2016.36.007.
[15]SMIT I,HARRISON L,LETZKUS L,et al.What Factors Are Associated With the Development of Pressure Ulcers in a Medical Intensive Care Unit?[J].Dimens Crit Care Nurs,2016,35(1):37-41.DOI:10.1097/DCC.0000000000000153.
[16]张颖,高瑞雪,万乐,等.心血管病术后病人压疮发生的危险因素分析[J].护理研究,2016,30(18):2263-2265.DOI:10.3969/j.issn.1009-6493.2016.18.030.
[17]陈晓媚,高文,朱瑞萍,等.心血管手术患者压疮危险因素的研究进展[J].中华现代护理杂志,2018,24(6):738-741.DOI:10.3760/cma.j.issn.1674-2907.2018.06.031.
[18]陈丽,宋锡发,郭秀萍.老年住院患者压疮的相关因素分析及护理对策[J].中国实用护理杂志,2012,28(18):80-81.DOI:10.3760/cma.j.issn.1672-7088.2012.18.150.
[19]朴玉粉,邓述华,周玉洁,等.压疮风险评估工具与预防进展[J].中国护理管理,2014,14(7):680-683.DOI:10.3969/j.issn.1672-1756.2014.07.003.
[2]BRADEN B J.The Braden scale,25 years later[J].Perspect Infirm,2014,11(4):33-34.
[3]曹艳,王娟,王艳,等.3种压疮评估量表对肿瘤内科患者临床效度的测定[J].新疆医科大学学报,2016,39(8):981-983,988.DOI:10.3969/j.issn.1009-5551.2016.08.012.
[4]陈晓艳.3种压疮危险评估量表在神经外科ICU病人中的应用研究[J].护理研究,2016,30(9):1081-1083.DOI:10.3969/j.issn.1009-6493.2016.09.016.
[5]Wound,Ostomy and Continence Nurses Society-Wound Guidelines Task Force.WOCN 2016 Guideline for Prevention and Management of Pressure Injuries(Ulcers):An Executive Summary[J].J Wound Ostomy Continence Nurs,2017,44(3):241-246.DOI:10.1097/WON.0000000000000321.
[6]刘莹,吴欣娟.压疮风险评估量表的研究进展[J].中华现代护理杂志,2017,23(10):1443-1447.DOI:10.3760/cma.j.issn.1674-2907.2017.10.029.
[7]董晓江,吕巧芸.压疮防治新进展[J].护理研究,2010,24(17):1516-1518.DOI:10.3969/j.issn.1009-6493.2010.17.005.
[8]倪亚,张芳平,沈欣.心内直视术后压力性皮肤损伤的回顾性分析[J].心脑血管病防治,2018,18(1):83-85.DOI:10.3969/j.issn.1009_816x.2018.01.029.
[9]黄家诚.循证护理在心脏直视手术后压疮预防中的应用[J].微创医学,2012,7(5):563-564.DOI:10.3969/j.issn.1673-6575.2012.05.051.
[10]智红晓,宋葆云,杨巧芳.应用集束化护理预防成人体外循环心脏手术患者围手术期急性压疮的实践[J].中国护理管理,2016,16(6):840-842.DOI:10.3969/j.issn.1672-1756.2016.06.029.
[11]肖海涛,邓云霞,刘颖.压疮危险因素评估量表在ICU患者中预防压疮应用现状研究进展[J].临床与病理杂志,2016,36(6):824-829.DOI:10.3978/j.issn.2095-6959.2016.06.020.
[12]于彬彬,宁华秀,陈晓琳.Norton量表对老年患者全髋关节置换术后并发症预测效果的前瞻性研究[J].中国实用护理杂志,2017,33(35):2734-2737.DOI:10.3760/cma.j.issn.1672-7088.2017.35.004.
[13]梁慧敏,王春梅.3种压疮危险评估表对脊髓损伤病人压疮预测效果的比较研究[J].护理研究,2010,24(12):1064-1065.DOI:10.3969/j.issn.1009-6493.2010.12.015.
[14]何侃侃,姚金兰.成人压疮风险评估量表在病人围术期的应用进展[J].全科护理,2016,14(36):3799-3801.DOI:10.3969/j.issn.1674-4748.2016.36.007.
[15]SMIT I,HARRISON L,LETZKUS L,et al.What Factors Are Associated With the Development of Pressure Ulcers in a Medical Intensive Care Unit?[J].Dimens Crit Care Nurs,2016,35(1):37-41.DOI:10.1097/DCC.0000000000000153.
[16]张颖,高瑞雪,万乐,等.心血管病术后病人压疮发生的危险因素分析[J].护理研究,2016,30(18):2263-2265.DOI:10.3969/j.issn.1009-6493.2016.18.030.
[17]陈晓媚,高文,朱瑞萍,等.心血管手术患者压疮危险因素的研究进展[J].中华现代护理杂志,2018,24(6):738-741.DOI:10.3760/cma.j.issn.1674-2907.2018.06.031.
[18]陈丽,宋锡发,郭秀萍.老年住院患者压疮的相关因素分析及护理对策[J].中国实用护理杂志,2012,28(18):80-81.DOI:10.3760/cma.j.issn.1672-7088.2012.18.150.
[19]朴玉粉,邓述华,周玉洁,等.压疮风险评估工具与预防进展[J].中国护理管理,2014,14(7):680-683.DOI:10.3969/j.issn.1672-1756.2014.07.003.