ICU患者压力性损伤预测风险列线图模型的建立
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摘要
目的分析ICU重症患者发生压力性损伤的危险因素,建立压力性损伤发生风险的列线图模型。方法抽取2017年1—12月某三级甲等医院入住ICU且符合纳入标准的341例患者作为研究对象,依据患者住院期间压疮发生情况,采用自制调查表回顾性收集患者临床资料,运用Logistic回归分析压力性损伤的影响因素,建立预测压力性损伤发生的列线图模型,分别用H-L偏差度检验和ROC曲线评估预测模型的偏差度和区分度。结果本次研究的压力性损伤发生率为16.4%。多因素Logistic回归分析显示:脑卒中、糖尿病、乳酸、有创机械通气、性别为压力性损伤发生的危险因素(P<0.05);血红蛋白及血清白蛋白为压力性损伤发生的保护性因素(P<0.05)。依此建立的列线图模型具有较好的准确度(H-L检验:χ~2=4.561,P=0.683)和区分度(AUC=0.886,95%CI:0.749～0.970)。结论本次研究整合了压力性损伤的7项影响因素,依此建立的列线图预测模型具有较好的预测价值,依据个体在列线图中各个危险因素的不同水平指导医护人员采取有针对性的预防策略,从而有效预防ICU患者压力性损伤的发生。
Objective To analyze the risk factors of pressure injury(PI) in ICU patients and establish a nomogram model for predicting the risk of PI. Methods A total of 341 patients admitted to ICU from January 2017 to December 2017 who met the inclusion criteria were selected as research subjects. According to the occurrence of pressure sores in patients, the clinical data of patients during hospitalization were retrospectively collected by a self-designed questionnaire. Logistic regression analysis was used to determine independent risk factors of PI. Nomogram model for predicting the occurrence of PI was established. H-L deviation test and ROC curve were used to evaluate the deviation and discrimination of the prediction model respectively. Results The incidence of PI in this study was 16.4%. Multivariate logistic regression analysis showed that stroke, diabetes, lactic acid, invasive mechanical ventilation, gender, hemoglobin and serum albumin were independent influence factors for the occurrence of PI(all P <0.05). The established nomogram model had good accuracy(H-L test: χ~2=4.561, P=0.683) and discrimination(AUC=0.886, 95%CI:0.749～0.970). Conclusion This study integrates 7 independent influence factors of PI, and the corresponding nomogram prediction model has good predictive value, which is helpful for medical personnel to adopt targeted prevention strategies, thus to effectively prevent the occurrence of PI in ICU patients.
Objective To analyze the risk factors of pressure injury(PI) in ICU patients and establish a nomogram model for predicting the risk of PI. Methods A total of 341 patients admitted to ICU from January 2017 to December 2017 who met the inclusion criteria were selected as research subjects. According to the occurrence of pressure sores in patients, the clinical data of patients during hospitalization were retrospectively collected by a self-designed questionnaire. Logistic regression analysis was used to determine independent risk factors of PI. Nomogram model for predicting the occurrence of PI was established. H-L deviation test and ROC curve were used to evaluate the deviation and discrimination of the prediction model respectively. Results The incidence of PI in this study was 16.4%. Multivariate logistic regression analysis showed that stroke, diabetes, lactic acid, invasive mechanical ventilation, gender, hemoglobin and serum albumin were independent influence factors for the occurrence of PI(all P <0.05). The established nomogram model had good accuracy(H-L test: χ~2=4.561, P=0.683) and discrimination(AUC=0.886, 95%CI:0.749～0.970). Conclusion This study integrates 7 independent influence factors of PI, and the corresponding nomogram prediction model has good predictive value, which is helpful for medical personnel to adopt targeted prevention strategies, thus to effectively prevent the occurrence of PI in ICU patients.
引文
[1]褚万立,郝岱峰.美国国家压疮咨询委员会2016年压力性损伤的定义和分期解读[J].中华损伤与修复杂志(电子版), 2018,13(1):64-68.DOI:10.3877/cma.j.issn.1673-9450.2018.01.014.
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[8]赵丽娟,王富艳,胡俊霞.预测腹部手术切口感染风险的列线图模型的建立[J].中华现代护理杂志,2018,24(14):1633-1638.DOI:10.3760/cma.j.issn.1674-2907.2018.14.007.
[9]王娇,吴玉梅.建立子宫内膜非典型增生风险预测列线图[J].中国妇产科临床杂志, 2014,15(3):237-240.DOI:10.13390/j.issn.1672-1861.2014.03.014.
[10]霍婉君,冯素云,曾繁端,等. ICU患者压疮危险因素的Meta分析[J].齐鲁护理杂志, 2018,24(24):35-39.DOI:10.3969/j.issn.1006-7256.2018.24.012.
[11]邓小红,王乔凤,李明珂,等. ICU住院患者发生院内获得性压疮的危险因素分析[J].中国护理管理, 2016,16(6):836-839.DOI:10.3969/j.issn.1672-1756.2016.06.028.
[12] Edsberg L E, Black J M, Goldberg M, et al. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System:Revised Pressure Injury Staging System[J]. J Wound Ostomy Continence Nurs, 2017, 43(6):585.
[13]宋文静,管晓萍,李蓉,等.成人开颅手术压疮的风险因素研究[J].中国全科医学, 2015,18(11):1270-1273.DOI:10.3969/j.issn.1007-9572.2015.11.010.
[14]蒲丽辉,胡秀英,刘祚燕.老年患者压疮风险现状调查与影响因素分析[J].中国护理管理, 2015,15(5):540-543.DOI:10.3969/j.issn.1672-1756.2015.05.009.
[15]郭静,李化龙,张大庆. ICU重症伴休克患者动脉血乳酸水平监测的临床意义[J].中国医学创新,2015,12(22):151-153.DOI:10.3969/j.issn.1674-4985.2015.22.061.
[16]徐萍,唐冰,翟怀香,等.床头抬高角度对机械通气重症患者呼吸机相关性肺炎及压疮影响的Meta分析[J].中华现代护理杂志,2017,23(23):3002.DOI:10.3760/cma.j.issn.1674-2907.2017.23.014.
[17]中华医学会重症医学分会.机械通气临床应用指南(2006)[J].中国危重病急救医学, 2007, 19(2):65-72.DOI:10.3760/j.issn:1003-0603.2007.02.002.
[18] Shahin E S, Dassen T, Halfens R J. Incidence, Prevention and Treatment of Pressure Ulcers in Intensive Care Patients:A Longitudinal Study[J]. Int J Nurs Stud, 2009,46(4):413-421.DOI:10.1016/j.ijnurstu.2008.02.011.
[19]李杨,潘莹莹,姜丽萍,等.压疮及防治的研究进展[J].中华现代护理杂志, 2015,21(9):1107-1110.DOI:10.3760/j.issn.1674-2907.2015.09.043.
[20] Posthauer M E, Banks M, Dorner B, et al. The Role of Nutrition for Pressure Ulcer Management:National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance White Paper[J].Advances in Skin&Wound Care, 2015, 28(4):189-190.DOI:10.1097/01.ASW.0000461911.31139.62.
[21] Anthony D, Rafter L, Reynolds T, et al. An Evaluation of Serum Albumin and the Sub-scores of the Waterlow Score in Pressure Ulcer Risk Assessment[J]. J Tissue Viability,2011, 20(3):89-99.DOI:10.1016/j.jtv.2011.04.001.
[22] Keelaghan E, Margolis D, Zhan M, et al. Prevalence of Pressure Ulcers on Hospital Admission among Nursing Home Residents Transferred to the Hospital[J].Wound Repair Regen,2010,16(3):331-336.DOI:10.1111/j.1524-475X.2008.00373.x.
[23]关欣,王蕾,邵欣.重症医学科1056例患者中压疮发生情况的调查研究[J].中华护理杂志,2014,49(7):840-843.DOI:10.3761/j.issn.0254-1769.2014.07.019.
[24]蒋琪霞,刘洁. 64例医院内获得性压疮的原因分析及对策[J].中华现代护理杂志, 2014,20(11):1244-1247.DOI:10.3760/j.issn.1674-2907.2014.11.002.
[2]曾文君.早期预警干预对神经外科患者压疮发生情况的影响[J].中国现代医学杂志, 2015,25(6):101-104.DOI:10.3969/j.issn.1005-8982.2015.06.023.
[3] Rn E S M S, Theo Dassen R N, Halfens R J G. Pressure Ulcer Prevention in Intensive Care Patients:Guidelines and Practice[J]. J Eval Clin Pract, 2010, 15(2):370-374. DOI:10.1111/j.1365-2753.2008.01018.x.
[4] Terekeci H, Kucukardali Y, Top C, et al. Risk Assessment Study of the Pressure Ulcers in Intensive Care Unit Patients[J]. Eur J Intern Med,2009, 20(4):394-397.DOI:10.1016/j.ejim.2008.11.001.
[5]杨小辉,赵媛媛,钮美娥. ICU医疗器械相关压力性损伤的研究现状[J].护理学报, 2017,24(13):49-53.DOI:10.16460/j.issn1008-9969.2017.13.049.
[6]霍婉君,刘荣敏,冯素云,等. 2007-2016年我国压疮发生危险因素研究的文献计量分析[J].护理学报, 2017,24(20):14-16.DOI:10.16460/j.issn1008-9969.2017.20.014.
[7]李凤玲,吴晓燕,张丽娟.预测骨折手术患者并发术中压疮风险的列线图模型的建立[J].中国实用护理杂志, 2018,34(4):279-283.DOI:10.3760/cma.j.issn.1672-7088.2018.04.009.
[8]赵丽娟,王富艳,胡俊霞.预测腹部手术切口感染风险的列线图模型的建立[J].中华现代护理杂志,2018,24(14):1633-1638.DOI:10.3760/cma.j.issn.1674-2907.2018.14.007.
[9]王娇,吴玉梅.建立子宫内膜非典型增生风险预测列线图[J].中国妇产科临床杂志, 2014,15(3):237-240.DOI:10.13390/j.issn.1672-1861.2014.03.014.
[10]霍婉君,冯素云,曾繁端,等. ICU患者压疮危险因素的Meta分析[J].齐鲁护理杂志, 2018,24(24):35-39.DOI:10.3969/j.issn.1006-7256.2018.24.012.
[11]邓小红,王乔凤,李明珂,等. ICU住院患者发生院内获得性压疮的危险因素分析[J].中国护理管理, 2016,16(6):836-839.DOI:10.3969/j.issn.1672-1756.2016.06.028.
[12] Edsberg L E, Black J M, Goldberg M, et al. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System:Revised Pressure Injury Staging System[J]. J Wound Ostomy Continence Nurs, 2017, 43(6):585.
[13]宋文静,管晓萍,李蓉,等.成人开颅手术压疮的风险因素研究[J].中国全科医学, 2015,18(11):1270-1273.DOI:10.3969/j.issn.1007-9572.2015.11.010.
[14]蒲丽辉,胡秀英,刘祚燕.老年患者压疮风险现状调查与影响因素分析[J].中国护理管理, 2015,15(5):540-543.DOI:10.3969/j.issn.1672-1756.2015.05.009.
[15]郭静,李化龙,张大庆. ICU重症伴休克患者动脉血乳酸水平监测的临床意义[J].中国医学创新,2015,12(22):151-153.DOI:10.3969/j.issn.1674-4985.2015.22.061.
[16]徐萍,唐冰,翟怀香,等.床头抬高角度对机械通气重症患者呼吸机相关性肺炎及压疮影响的Meta分析[J].中华现代护理杂志,2017,23(23):3002.DOI:10.3760/cma.j.issn.1674-2907.2017.23.014.
[17]中华医学会重症医学分会.机械通气临床应用指南(2006)[J].中国危重病急救医学, 2007, 19(2):65-72.DOI:10.3760/j.issn:1003-0603.2007.02.002.
[18] Shahin E S, Dassen T, Halfens R J. Incidence, Prevention and Treatment of Pressure Ulcers in Intensive Care Patients:A Longitudinal Study[J]. Int J Nurs Stud, 2009,46(4):413-421.DOI:10.1016/j.ijnurstu.2008.02.011.
[19]李杨,潘莹莹,姜丽萍,等.压疮及防治的研究进展[J].中华现代护理杂志, 2015,21(9):1107-1110.DOI:10.3760/j.issn.1674-2907.2015.09.043.
[20] Posthauer M E, Banks M, Dorner B, et al. The Role of Nutrition for Pressure Ulcer Management:National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance White Paper[J].Advances in Skin&Wound Care, 2015, 28(4):189-190.DOI:10.1097/01.ASW.0000461911.31139.62.
[21] Anthony D, Rafter L, Reynolds T, et al. An Evaluation of Serum Albumin and the Sub-scores of the Waterlow Score in Pressure Ulcer Risk Assessment[J]. J Tissue Viability,2011, 20(3):89-99.DOI:10.1016/j.jtv.2011.04.001.
[22] Keelaghan E, Margolis D, Zhan M, et al. Prevalence of Pressure Ulcers on Hospital Admission among Nursing Home Residents Transferred to the Hospital[J].Wound Repair Regen,2010,16(3):331-336.DOI:10.1111/j.1524-475X.2008.00373.x.
[23]关欣,王蕾,邵欣.重症医学科1056例患者中压疮发生情况的调查研究[J].中华护理杂志,2014,49(7):840-843.DOI:10.3761/j.issn.0254-1769.2014.07.019.
[24]蒋琪霞,刘洁. 64例医院内获得性压疮的原因分析及对策[J].中华现代护理杂志, 2014,20(11):1244-1247.DOI:10.3760/j.issn.1674-2907.2014.11.002.