ICU老年髋关节置换术后病人压力性损伤风险预测模型的构建  

Construction of risk prediction model for pressure ulcer of elderly patients underwent hip joint replacement in ICU

作　　者：董正惠 李阳[2] 祁进芳 李振刚 王志伟 陶珍珍 DONG Zhenghui;LI Yang;QI Jinfang;LI Zhengang;WANG Zhiwei;TAO Zhenzhen(The Sixth Affiliated Hospital of Xinjiang Medical University,Xinjiang 830092 China)

机构地区：[1]新疆医科大学第六附属医院,新疆830092 [2]北京大学第一医院 [3]新疆医科大学护理学院

出　　处：《护理研究》2022年第18期3224-3228,共5页Chinese Nursing Research

基　　金：新疆维吾尔自治区自然科学基金资助项目,编号:2021D01C455。

摘　　要：目的:分析重症监护病房(ICU)老年髋关节置换术后病人发生压力性损伤的影响因素,构建风险预测模型。方法:选取2020年11月—2021年8月某三级甲等医院的248例ICU老年髋关节置换术后病人为研究对象,采用单因素分析和Logistic回归分析筛选ICU老年髋关节置换术后病人发生压力性损伤的影响因素,构建ICU老年髋关节置换术后病人压力性损伤风险预测模型,并对模型进行内部验证。结果:248例病人中有35例(14.1%)病人发生了压力性损伤,Logistic回归分析结果显示,年龄较大、体质指数<24 kg/m^(2)或≥28 kg/m^(2)、有糖尿病、美国麻醉医师协会分级≥Ⅲ级和手术时间≥3 h为压力性损伤发生的独立危险因素(P<0.05);血清清蛋白≥35 g/L为压力性损伤发生的独立保护因素(P<0.05)。基于以上因素建立的列线图模型受试者工作特征曲线下面积为0.935,灵敏度为80.0%,特异度92.5%。H-L检验显示χ^(2)=8.462,P=0.390。校准图显示模型预测的概率与实际观察形成的概率存在较好的一致性。结论:本研究构建的ICU老年髋关节置换术后病人压力性损伤风险预测模型具有较好的风险预测能力,可作为一种有效的评估工具。Objective:To analyze influence factors of pressure ulcer of elderly patients underwent hip joint replacement in intensive care unit(ICU),and to construct a risk prediction model.Methods:248 elderly patients underwent hip joint replacement in ICU of a tertiary grade A hospital were selected as research subjects from November 2020 to August 2021.The influencing factors of pressure ulcer pressure ulcer of elderly patients underwent hip joint replacement in ICU were screened by univariate analysis and Logistic regression analysis,and risk prediction model of pressure ulcer of elderly patients underwent hip joint replacement in ICU was constructed and validated internally.Results:Among 248 patients,35 patients(14.1%)had pressure injury.Logistic regression analysis showed that older age,body mass index<24 kg/m^(2) or≥28 kg/m^(2),with diabetes,American Society of Anesthesiologists grade≥Ⅲ and operation time≥3 h were independent risk factors for pressure ulcer(P<0.05),and serum albumin≥35 g/L was independent protective factor for pressure ulcer(P<0.05).The area under the receiver operating characteristic curve of nomogram model established based on the above factors was 0.935,the sensitivity was 80.0%,and the specificity was 92.5%.H-L test showed χ^(2)=8.462,P=0.390.The calibration chart showed that probability predicted by the model was consistent with the probability formed by actual observation.Conclusions:The risk prediction model for pressure ulcer of elderly patients underwent hip joint replacement in ICU constructed in this study has good risk identification ability and can be used as effective evaluation tool.

关 键 词：重症监护 老年人 髋关节置换 压力性损伤 影响因素 预测模型 护理 

分 类 号：R473.6[医药卫生—护理学]