机构地区:[1]蚌埠医科大学第一附属医院产科,安徽蚌埠233004 [2]蚌埠医科大学第一附属医院妇产科
出 处:《中华全科医学》2024年第11期1976-1980,共5页Chinese Journal of General Practice
基 金:安徽省科学研究重点项目(2022AH051536)。
摘 要:目的探索妇科手术患者发生医院获得性压疮的风险因素,并基于这些因素开发一个有效的预测工具。方法通过文献检索确定已知的压疮风险因素,回顾性收集2018年1月—2023年10月于蚌埠医科大学第一附属医院128例(其中64例发生医院获得性压疮和64例未发生)行妇科手术患者的临床资料,分析2组患者在已知风险因素中的差异。之后采用二元多因素logistic回归分析评估不同风险因素的重要性,确定医院获得性压疮发生的风险因素。再通过R软件开发压疮风险预测模型,并对模型进行内部验证。结果2组患者年龄、BMI(<23)、美国麻醉医师协会(ASA)分级(1~2级和≥3级)、术前Braden评分(≤14分)、贫血、高血压、呼吸道疾病以及住院时间方面差异均有统计学意义(P<0.05)。通过logistic回归分析确认了8个风险因素:年龄≥70岁、住院时间、ASA分级≥3级、BMI<23、术前Braden评分≤14分、贫血、呼吸道疾病和高血压。预测模型的c统计量为0.81,具有良好的风险区分能力,模型选取临界值≥6分作为压疮发生的强预测指标,其阳性预测值为73.9%,阴性预测值为80.5%。结论本研究明确了压疮发生的风险因素(年龄≥70岁、住院时间长、ASA分级≥3级、BMI<23、术前Braden评分≤14分、贫血、呼吸道疾病和高血压),基于此开发的压疮风险预测工具,具有可靠的阳性预测率,为临床护理工作的开展提供了理论依据。Objective This study aims to explore the risk factors for hospital-acquired pressure ulcers in patients undergoing gynecological surgery and to develop an effective prediction tool based on these factors.Methods Risk factors for pressure ulcers were identified through a literature review.Clinical data from 128 patients(64 with hospital-acquired pressure ulcers and 64 without)who underwent gynecological surgery at the First Affiliated Hospital of Bengbu Medical University from January 2018 to October 2023 were retrospectively collected.Differences in known risk factors between the two groups were analyzed.Binary multifactorial logistic regression analysis was used to evaluate the importance of different risk factors and identify those associated with pressure ulcer development.A pressure ulcer risk prediction model was developed using R software and internally validated.Results Statistically significant differences were observed between the two groups in age,BMI(<23),American Society of Anesthesiologists(ASA)classification(1-2 and≥3),preoperative Braden score(≤14),anemia,hypertension,respiratory disease,and length of hospital stay(P<0.05).Logistic regression analysis confirmed 8 risk factors:age≥70 years,length of hospital stay,ASA level≥3,BMI<23,preoperative Braden score≤14,anemia,respiratory disease,and hypertension.The prediction model had a C-statistic of 0.81,indicating good risk discrimination.A cut-off value of≥6 points was determined to be a strong predictor of pressure ulcer occurrence,with a positive predictive value of 73.9%and a negative predictive value of 80.5%.Conclusion This study identified key risk factors of pressure ulcers(age≥70 years,length of hospital stay,ASA level≥3,BMI<23,preoperative Braden score≤14,anemia,respiratory disease,and hypertension)and developed a reliable risk prediction tool.This tool offers a theoretical basis for enhancing clinical nursing care and preventing pressure ulcers in gynecological surgery patients.
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