预测早产儿医用粘胶相关性皮肤损伤风险的列线图模型的建立  

A nomogram prediction of medical adhesive-related skin injury in premature infants

作　　者：李玮桐 向美芹[1] 赵希平[1] 单雪 杨富国[2] Li Weitong;Xiang Meiqin;Zhao Xiping;Shan Xue;Yang Fuguo(NICU,Affiliated Hospital of Ji′ning Medical University,Ji′ning 272000,China;School of Nursing,Qingdao University,Qingdao 266021,China)

机构地区：[1]济宁医学院附属医院NICU,272000 [2]青岛大学护理学院,266021

出　　处：《中国实用护理杂志》2020年第18期1394-1399,共6页Chinese Journal of Practical Nursing

基　　金：济宁医学院附属医院“苗圃”科研计划(MP-MS-2019-014)。

摘　　要：目的:分析早产儿发生医用粘胶相关性皮肤损伤(MARSI)的危险因素,建立个体化预测早产儿发生MARSI风险的列线图模型。方法:抽取2018年7—9月NICU住院且符合纳排标准的268例早产儿作为研究对象,采用自制调查表收集临床资料,运用Logistic回归分析,分析发生MARSI的危险因素;运用R软件建立预测早产儿发生MARSI风险的列线图模型,采用一致性指数、校正曲线、决策曲线进行模型验证。结果:NICU早产儿MARSI发生率为23.9%(64/268)。胎龄(28~32周)(P值为0.021,OR值为2.736,95%CI 1.163~6.435)、水肿(P<0.01,OR值为33.782,95%CI 10.510~108.583)、孕母糖尿病(P值为0.039,OR值为16.011,95%CI 1.146~223.692)、易撕胶带(P值为0.027,OR值为13.567,95%CI 1.340~137.311)均是早产儿发生MARSI的独立危险因素。列线图模型C-index为87.29%,具有中等区分度;校正曲线显示预测概率与实际发生概率趋于一致。结论:基于胎龄、皮肤状态、孕母期疾病、粘胶产品等指标建立的预测早产儿MARSI发生风险的列线图模型,具有较好的区分度和准确度,可实现个体化预测MARSI发生风险,筛选高风险人群,有临床意义。Objective To analyze the risk factors of medical adhesive-related skin injury(MARSI)in preterm infants to establish a nomogram model to predict the risk of MARSI.Methods From July to September 2018,268 premature infants who were hospitalized in NICU were enrolled in this study.Their clinical data were analyzed and univariate analysis was used to detemine the risk factors related to MARSI,The significant variables were included in the multivariate logistic regression analysis to analyze the independent risk factors for MARSI.Then the R software was used to establish a predictive nomogram model,Bootstrap method was used to validate the nomogram model and the consistency test of the correction curve was used to explore the predictive efficacy of the model in predicting the MARSI.Results A total of 64 cases out of 268 premature infants had MARSI.The prevalence rate was 23.9%(64/268).Birth age(28 to 32 weeks)(P value was 0.021,OR value was 2.736,95%CI 1.163-6.435),edema(P<0.01,OR value was 33.782,95%CI 10.510-108.583),maternal diabetes(P value was 0.039,OR value was 16.011,95%CI 1.146-223.692),easy to tear tape(P value was 0.027,OR value was 13.567,95%CI 1.340-137.311)were all independent risk factors for MARSI.The nomogram model showed a conformance-index of 87.29%,while the consistency test of the correction curve showed that the prediction probability is consistent with the actual occurrence probability.Conclusions The nomogram built based on the indexes of fetal age,skin state,maternal disease,mucous product has good discrimination and accuracy which could be helpful for screening the patients with high risk,with potentially high clinical application value.

关 键 词：婴儿 早产 医用粘胶相关性皮肤损伤 列线图 

分 类 号：R473.72[医药卫生—护理学]