神经外科患者非计划重返ICU发生现状及影响因素研究  

Study on the current status and influencing factors of unplanned readmission to ICU for neurosurgical patients

作　　者：王军[1] 卢舒颖 纪媛媛 王娜[1] 欧梦仙 张娜芹 崔丽 李莉[1] 闫梦琦 付思晨 刘云云[1] WANG Jun;LU Shuying;JI Yuanyuan;WANG Na;OU Mengxian;ZHANG Naqin;CUI Li;LI Li;YAN Mengqi;FU Sichen;LIU Yunyun

机构地区：[1]首都医科大学宣武医院神经外科,北京市100053

出　　处：《中华护理杂志》2024年第23期2853-2860,共8页Chinese Journal of Nursing

基　　金：首都卫生发展科研专项(首发2022-4-20114);首都医科大学2023年度数智护理基础临床协同研究专项立项课题(SZHL23Z03);首都医科大学宣武医院2024年度护理专项课题(HLQN2024008)。

摘　　要：目的了解神经外科患者非计划重返ICU发生现状及影响因素,旨在为临床医护人员制订有针对性的护理措施提供参考。方法回顾性收集2020年1月—2022年9月北京市某三级甲等医院神经外科ICU转出患者的临床资料,使用倾向性评分匹配后得到组间协变量均衡的样本,并应用单因素和Logistic回归分析神经外科患者非计划重返ICU的影响因素。结果共纳入4789例患者资料,159例(3.32%)患者发生非计划重返ICU;以呼吸衰竭和肺部感染为主的呼吸系统并发症是造成神经外科患者非计划重返ICU的首要原因。Logistic回归分析显示,机械通气时长、首次入住ICU时长、气管插管次数≥2次、留置脑室引流管或腰大池引流管、转出ICU时存在轻中度意识障碍、白细胞计数低、血红蛋白计数低是神经外科患者非计划重返ICU的影响因素(P<0.05)。结论医护人员应重视非计划重返ICU高风险人群,及时评估其转出风险,开展有针对性的护理措施并加强护理质量控制,以降低神经外科患者非计划重返ICU发生率。Objective To investigate the current status of unplanned readmission to the ICU in neurosurgical patients and to study its influencing factors,aiming to inform the construction of targeted nursing interventions for medical staff.Methods From January 2020 to September 2022,the relevant data of patients transferred out from the ICU of a tertiary-level hospital in Beijing were retrospectively analyzed.After using propensity score matching,a sample with balanced covariates between groups was obtained,and single-factor and Logistic regression analyses were used to study the influencing factors of unplanned readmission to the ICU in neurosurgical patients.Results The data of a total of 4789 patients were included,and 159 patients(3.32%)had unplanned readmission to the ICU.Respiratory failure and pulmonary infection were the main respiratory complications causing unplanned readmission to the ICU in neurosurgical patients.Logistic regression analysis showed that the duration of mechanical ventilation,the length of the first stay in the ICU,tracheal intubations≥2 times,presence of cerebrospinal fluid drainage tube or lumbar drainage tube,existence of mild to moderate consciousness disorder at discharge from ICU,low white blood cell count,and low hemoglobin count were independent influencing factors for unplanned readmission to ICUs in neurosurgical patients(P<0.05).Conclusion Medical staff should pay attention to the high-risk group of unplanned return to the ICU,assess the risk of transfer in a timely manner,carry out targeted nursing measures and strengthen the quality of nursing care to reduce the incidence of unplanned return to the ICU in neurosurgical patients.

关 键 词：神经外科 重症监护病房 非计划重返 横断面研究 倾向性评分匹配 护理 

分 类 号：R473.6[医药卫生—护理学]