ICU经口气管插管老年病人口腔黏膜压力性损伤风险预测模型的构建  

Construction of risk prediction model of oral mucosal pressure injury in elderly patients with oral tube intubation in ICU

作　　者：张树光 姜洪彪 侯杰[1] 刘茜[1] 刘淑娟[1] ZHANG Shuguang;JIANG Hongbiao;HOU Jie;LIU Qian;LIU Shujuan(Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Shandong 250014 China)

机构地区：[1]山东中医药大学附属医院,山东250014

出　　处：《护理研究》2024年第20期3592-3597,共6页Chinese Nursing Research

基　　金：山东省医药卫生科技发展计划项目,编号:202114050460。

摘　　要：目的:构建ICU经口气管插管老年病人口腔黏膜压力性损伤风险预测模型,并进行内外部验证。方法:采用便利抽样法,选取2022年1月—2023年8月在山东省某三级甲等医院ICU住院的533例老年病人为研究对象。通过单因素分析和Logistic回归分析确定影响因素,构建列线图预测模型。通过受试者工作特征曲线下面积和Hosmer-Lemeshow检验评估模型的区分度和校准度,采用决策曲线分析(DCA)评估模型的临床有效性。结果:性别、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、血红蛋白、血清白蛋白、俯卧位通气、使用血管收缩药物、气管插管留置时间是ICU经口气管插管老年病人口腔黏膜压力性损伤的影响因素(P<0.05)。构建的模型受试者工作特征曲线下面积为0.870,Hosmer-Lemeshow检验显示该模型校准曲线与理想曲线拟合较好,外部验证预测准确率为85.0%,DCA为0.03~0.50,表现为正的净效益。结论:构建的预测模型具有较好的预测效能,可为临床早期识别ICU经口气管插管老年病人发生口腔黏膜压力性损伤的高危人群提供参考。Objective:To construct the risk prediction model of oral mucosal pressure injury in elderly patients with oral tube intubation in ICU,and to verify it internally and externally.Methods:A total of 533 elderly patients hospitalized in the ICU of a tertiary grade A hospital in Shandong province from January 2022 to August 2023 were selected by convenience sampling method.The influence factors were determined by single factor analysis and Logistic regression analysis,and the prediction model of the Nomogram was constructed.The differentiation and calibration of the model were evaluated by the area under the receiver operating characteristic curve and the Hosmer-Lemeshow test.Decision curve analysis(DCA)was used to evaluate the clinical validity of the model.Results:Gender,APACHEⅡscores,hemoglobin,serum albumin,prone position ventilation,vasoconstrictor drugs,and endotracheal intubation retention time were the influencing factors of oral mucosal pressure injury in elderly patients with oral tube intubation in ICU(P<0.05).The area under the receiver operating characteristic curve of the constructed model was 0.870.Hosmer-Lemeshow test showed that the calibration curve of the model fitted well with the ideal curve.The prediction accuracy of external verification was 85.0%.And DCA ranged from 0.03 to 0.50,which showed a positive net benefit.Conclusions:The constructed risk prediction model has good predictive efficacy,and it can provide reference for early clinical identification of high-risk groups of oral mucosal pressure injury in elderly patients with oral tube intubation in ICU.

关 键 词：重症监护室 经口气管插管 压力性损伤 预测模型 影响因素 

分 类 号：R473[医药卫生—护理学]