慢性阻塞性肺疾病无创正压通气患者面部压疮发生的危险因素分析与风险预测模型的构建及检验  

Establishment and validation of a risk factor model for facial pressure ulcer in patients with chronic obstructive pulmonary disease undergoing noninvasive positive pressure ventilation

作　　者：申微军 陈琨[1] 丁美祝[1] Shen Weijun;Chen Kun;Ding Meizhu(Department of Respiration,Fangcun Hospital,Guangdong Hospital of Traditional Chinese Medicine,Guangzhou Guangdong,510145)

机构地区：[1]广东省中医院芳村医院呼吸科

出　　处：《护士进修杂志》2019年第24期2224-2228,共5页Journal of Nurses Training

摘　　要：目的调查分析慢性阻塞性肺疾病无创正压通气患者面部压疮的临床现状及影响因素,构建并验证其预测评分模型。方法回顾性收集2014年3月-2017年12月我院收治的328例慢性阻塞性肺疾病无创正压通气患者的临床资料,分为建模组197例,验证组131例;根据检查结果将建模组197例患者根据检查结果分为有压疮(38例)与无压疮(159例),分析可能影响面部压疮发生的相关危险因素;根据危险因素权重,构建预测评分模型。验证组验证模型的预测效能。结果 (1)单因素分析结果显示,体温、血清白蛋白、合并糖尿病、使用激素、使用心血管药物、缺氧、使用总时间和单次使用时间是影响患者发生面部压疮的危险因素,差异有统计学意义(P<0.05)。(2)当患者体温≥37.5℃、血清白蛋白<35 mg/L、合并糖尿病、使用激素、使用心血管药物、缺氧、通气总时间>48 h和单次通气时间>4 h时,患者面部压疮的发生率,差异有统计学意义(P<0.05)。(3)多因素Logistic回归分析结果显示,体温、血清白蛋白、合并糖尿病、使用激素、缺氧、通气总时间和单次通气时间是影响患者面部压疮发生的独立性危险因素。(4)利用ROC曲线对两组患者面部压疮发生率进行检验发现,建模组ROC曲线下面积为0.873,Hosmer-Lemeshow拟合优度检验(χ^2=4.574,P=0.583);验证组ROC曲线下面积为0.834,Hosmer-Lemeshow拟合优度检验(χ^2=3.978,P=0.503)。模型拟合效度好,预测价值高。(5)依据该预测评分系统可分为低危、中危、高危、极高危4个等级,两组患者的Pearson列联系数分别为0.373和0.401,差异均有统计学意义(P<0.001)。结论慢性阻塞性肺疾病无创正压通气患者发生面部压疮的比例较高,影响患者面部压疮发生的因素较多,医护人员应加强关注。预测评分模型具有较高的预测能力和判别能力,能为患者的不良事件预防提供参考依据。Objective To study the clinical status and influencing factors of facial pressure ulcer in patients with chronic obstructive pulmonary disease undergoing noninvasive positive pressure ventilation, and to construct and validate its predictive scoring model. Methods The clinical data of 328 patients with chronic obstructive pulmonary disease undergoing noninvasive positive pressure ventilation from March 2014 to December 2017 were retrospectively collected. The predictive scoring model was constructed by logistic regression analysis and data types. The applicability of the predictive scoring system was evaluated by Hosmer-Lemeshow chi-square test and ROC curve analysis.Results A total of 59(18.0%) of 328 patients suffered facial pressure ulcers, including 38(19.3%) in the modeling group and 21(16.0%) in the validating group. Hosmer-Lemeshow chi-square test and ROC curve were used to verify the model. For Hosmer-Lemeshow test, the χ^2 value of the modeling group was 4.574(P=0.583), and the χ^2 value of the verification group was 3.978(P=0.503);for ROC curve analysis, the area under the curve of the modeling group was 0.873, 95% CI was(0.821, 0.926). The area under the curve of the verification group was 0.834, 95%CI is(0.744, 0.924). According to the predictive scoring system, it can be divided into four grades: low-risk, medium-risk, high-risk and very high-risk. The Pearson coefficient of the two groups were 0.373 and 0.401 respectively, which were statistically significant(P<0.001). Conclusion Patients with chronic obstructive pulmonary disease undergoing noninvasive positive pressure ventilation have a higher proportion of facial pressure ulcers. The predictive scoring model has a higher predictive ability and discriminant ability, and can provide a reference for the prevention of adverse events.

关 键 词：慢性阻塞性肺疾病 无创正压通气 面部压疮 风险因素 预测模型 护理 

分 类 号：R472[医药卫生—护理学] R563[医药卫生—临床医学]