汉化版切尔西物理功能评估量表在ICU成年人患者中的应用  

The Chinese version of the Chelsea Critical Care Physical Assessment Tool applied in critically ill patients

作　　者：吴雨晨[1] 王国强[1] 丁楠楠 Corner EJ 姜变通 岳伟岗[1] 张志刚[1] 魏花萍[1] Wu Yuchen;Wang Guoqiang;Ding Nannan;Comer EJ;Jiang Biantong;Yue Weigang;Zhang Zhigang;Wei Huaping(Intensive Care Unit,the First Affiliated Hospital of Lanzhou University,Lanzhou 730000,China;Department of Nursing,Henan Provincial People's Hospital,Zhengzhou 450000,China;Clinical Lead Respiratory Physiotherapist and Clinical Research Fellow,Chelsea and Westminster Hospital,London SW109NH,England;Department of Nursing,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]兰州大学第一医院重症医学科,730000 [2]河南省人民医院护理部,郑州450000 [3]Clinical Lead Respiratory Physiotherapist and Clinical Research Fellow,Chelsea and Westminster Hospital,(London,England SW109NH) [4]四川大学华西医院护理部,成都610041

出　　处：《中国实用护理杂志》2021年第26期2047-2053,共7页Chinese Journal of Practical Nursing

基　　金：甘肃省卫生健康行业科研计划(GSWSHL2020-11);兰州大学第--医院青年基金(ldyyyn2019-104)。

摘　　要：目的:探索中文版切尔西物理功能评估量表(CPAx-Chi)诊断ICU获得性衰弱(ICU-AW)的阈值及评估诊断价值。方法:学习CPAx-Chi量表使用细节和注意事项,由2名研究者同时采用CPAx-Chi量表和医学研究委员会肌力评分(MRC-Score)量表对兰州大学第一医院综合ICU的200例患者进行独立评估。以MRC-Score总分≤48分为标准,通过计算受试者工作特征曲线下面积(ROC AUC)、尤登指数(Youden's index,YI)及一致性检验,确定CPAx-Chi量表在诊断ICU-AW的阈值及价值。结果:以MRC-Score总分≤48分为标准,A组ROC AUC=0.899(95%CI 0.862~1.025);B组ROC AUC=0.874(95%CI 0.824~0.925);CPAx-Chi量表诊断ICU-AW的临界阈值为31.5分;A组最大YI=0.643,敏感度为87%,特异度为77%;B组最大YI=0.62,敏感度为75%,特异度为87%。CPAx-Chi量表诊断ICU-AW的临界阈值为30.5分,B组最大YI=0.62,敏感度为79%,特异度为83%。以CPAx-Chi≤31阈值,ICU-AW组和非ICU-AW组的CPAx-Chi评分差异有统计学意义;CPAx-Chi≤31分和MRC-Score≤48分诊断ICU-AW的一致性高,A组Kappa=0.845(P=0.02);B组数据Kappa=0.839(P=0.04),且有统计学意义。结论:CPAx-Chi量表评分≤31分是诊断ICU-AW的临界值,且具有良好的灵敏度和特异度。CPAx-Chi量表可以在我国重症医学领域推广应用。Objective:To explore the threshold and diagnostic value of Chinese version of the Chelsea Physical Function Assessment Tool(CPAx-Chi)for ICU acquired weakness(ICU-AW).Methods:To learn the details and precautions of the CPAx-Chi scale,and then two researchers used the CPAx-Chi scale and MRC-Score scale to independently evaluate 200 patients who come from a comprehensive ICU in a top first-class hospital in Gansu Province simultaneously.The best cut-off point and value of the CPAx-Chi scale in the diagnosis of ICU-AW were determined by calculating the Receiver Operating Characteristic(ROC)curve,the Youden index(YI)and the consistency test that are all based on the MRC-Score≤48.Results:The ROC Area Under Curve(AUC)of the CPAx-Chi scale diagnosis ICU-AW which based on the MRC-Score≤48 were as follows:ROC AUC of group A was 0.899(95%CI 0.862-1.025);ROC AUC of group B was 0.874(95%CI 0.824-0.925).When the best cut-off point of CPAx-Chi scale for diagnosis ICU-AW was 31.5,the maximum YI=0.643,the sensitivity was 87%,and the specificity was 77%in group A;and the maximum YI=0.62,the sensitivity was 75%,and the specificity was 87%in group B.Meanwhile,when the best cut-off point of CPAx-Chi scale for diagnosis ICU-AW was 30.5,the maximum YI=0.62,the sensitivity was 79%,and the specificity was 83%in group B.Taking the CPAx-Chi≤31 as the best cut-off point,the score differences in ICU-AW group and the non-ICU-AW group were not detected,A group(F value was 4.53,P=0.035)or B group(F value was 6.51,P=0.011).The consistency of CPAx-Chi≤31 and MRC-Score≤48 in the diagnosis of ICU-AW was high,and the Kappa=0.845(P=0.02)in the group A;the Kappa=0.839(P=0.04)in the group B,and the group differences were detected.Conclusions:CPAx-Chi≤31 is the best cut-off point for diagnosing ICU-AW,and has good sensitivity and specificity.CPAx-Chi scale can be popularized and applied in the critical care medicine in China.

关 键 词：ICU获得性衰弱 受试者工作特征曲线 阈值 灵敏度 特异度 

分 类 号：R473[医药卫生—护理学]