重症监护病房患者大便失禁相关性皮炎预测风险模型的建立和验证  

Development and Validation of A Predictive Risk Model for Fecal Incontinence Associated Dermatitis in ICU Patients

作　　者：史广玲[1] 徐建珍[1] 刘夕珍[1] 刘娟[1] 蒋学娟[1] 杜海燕[1] SHI Guangling;XU Jianzhen;LIU Xizhen;LIU Juan;JIANG Xujuan;DU Haiyan(Intensive Care Units,Nanjing Brain Hospital Affiliated to Nanjing Medical University,Nanjing 210029,Jiangsu Province,China)

机构地区：[1]南京医科大学附属脑科医院重症医学科,江苏南京210029

出　　处：《解放军护理杂志》2021年第11期37-40,45,共5页Nursing Journal of Chinese People's Liberation Army

摘　　要：目的分析重症监护室病房(intensive care unit,ICU)患者发生大便失禁相关性皮炎的危险因素,构建大便失禁相关性皮炎的列线图模型,并验证模型效果。方法采用回顾性分析法,收集2017年11月至2019年12月入住某三级甲等医院ICU的300例大便失禁患者资料,采用单因素和Logistic回归分析确定ICU患者大便失禁相关性皮炎的危险因素,据此构建列线图模型,通过受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)和霍斯默(Hosmer-Lemeshow,H-L)拟合优度检验评价模型的区分度和校准度。并收集2020年1-5月入住该院ICU的60例大便失禁患者的资料,对模型进行外部验证。结果ICU患者大便失禁相关性皮炎独立危险因素包括大便次数、大便性状、体温和白蛋白,预测模型具有较好的区分度和校准度[ROC曲线下面积=0.828、95%置信区间(confidence interval,CI)0.782~0.875,H-L拟合优度检验χ^(2)=7.659、P=0.364]。模型外部验证敏感度为84.62%,特异度为79.41%。结论ICU患者大便失禁相关性皮炎,受大便次数、大便性状、体温和白蛋白等多因素影响,以此建立的预测模型可较好地预测ICU大便失禁患者失禁相关性皮炎发生的风险。Objective To analyze the risk factors of fecal incontinence-related dermatitis in ICU patients,construct a nomogram model of fecal incontinence-related dermatitis,and verify the effect of the model.Methods The data of 300 patients with fecal incontinence admitted to the ICU of a tertiary hospital from November 2017 to December 2019 were collected by retrospective analysis.Univariate and logistic regression analysis were used to determine the risk factors of fecal incontinence-related dermatitis in ICU patients.Then,a nomogram model was constructed to evaluate the discrimination and calibration of the model by ROC curve and H-L goodness of fit test.The data of 60 patients with fecal incontinence admitted to the ICU of this hospital from January 2020 to May 2020 were collected for external validation of the model.Results The independent risk factors of fecal incontinence-related dermatitis in ICU patients included stool frequency,stool characteristics,body temperature and albumin,and the prediction model had good discrimination and calibration(AUC=0.828,95%CI:0.782 to 0.875,H-L goodness of fit test:χ^(2)=7.659,P=0.364).External validation of the model had a sensitivity of 84.62%and a specificity of 79.41%.Conclusions Fecal incontinence-related dermatitis in ICU patients is influenced by multiple factors such as stool frequency,stool characteristics,body temperature and albumin.The established prediction model can better predict the risk of incontinence-related dermatitis in ICU patients with fecal incontinence.

关 键 词：失禁相关性皮炎 大便失禁 重症监护病房 预测模型 

分 类 号：R47[医药卫生—护理学]