缺血性脑卒中患者院外用药偏差风险的列线图模型构建与验证  

Construction and verification of a nomogram model for predicting the risk of medication deviation in ischemic stroke patients after hospital discharge

作　　者：和青森 范崇桂[2] 杨钰[2] 郝丹 石玲红 孙晓林[3] He Qingsen;Fan Chonggui;Yang Yu;Hao Dan;Shi Linghong;Sun Xiaolin(Neurological Intensive Care Unit 1,Nanyang Central Hospital,Nanyang 473000,China;Department of Neurology,Nanyang Central Hospital,Nanyang 473000,China;Department of Nursing,Nanyang Central Hospital,Nanyang 473000,China)

机构地区：[1]南阳市中心医院神经重症一病区,南阳473000 [2]南阳市中心医院神经内科,南阳473000 [3]南阳市中心医院护理部,南阳473000

出　　处：《中华现代护理杂志》2024年第36期4945-4951,共7页Chinese Journal of Modern Nursing

摘　　要：目的构建缺血性脑卒中患者院外用药偏差风险的列线图模型,为临床护理策略制定提供思路。方法采用便利抽样法,选取2022年3月—2023年9月在南阳市中心医院神经内科住院的440例缺血性脑卒中患者为研究对象,收集基本资料,出院8周后采用用药偏差评估工具调查患者用药偏差情况,根据结果分为无用药偏差组和用药偏差组。应用单因素和二项Logistic回归分析探讨患者出院后用药偏差的独立危险因素,并建立列线图预测模型。结果最终424例患者完成资料收集,应答率为96.36%(424/440)。424例患者用药偏差发生率为58.02%(246/424)。二项Logistic回归分析结果显示,无固定照护者(OR=2.113,P=0.001)、合并慢病数量多(OR=1.773,P<0.001)、服药不依从(OR=2.443,P=0.003)、消极应对(OR=2.255,P<0.001)是缺血性脑卒中患者院外用药偏差发生的独立危险因素。基于以上4个危险因素建立风险列线图预测模型,H-L偏差度检验结果显示χ2=10.569,P=0.227,校正曲线均趋近于理想曲线,受试者工作特征曲线下面积为0.770(95%置信区间:0.584~0.866)。结论无固定照护者、服药依从性差、消极应对、合并慢病数量多是缺血性脑卒中患者用药偏差发生的独立危险因素。本研究构建的列线图模型具有良好的区分度和精准度,能够为制定相应护理策略提供依据。ObjectiveTo develop a nomogram model for predicting the risk of medication deviation in ischemic stroke patients after hospital discharge,providing insights for clinical nursing strategies.MethodsA convenience sampling method was used to select 440 ischemic stroke patients hospitalized in the Neurology Department of Nanyang Central Hospital from March 2022 to September 2023.Data on basic patient information and post-discharge medication deviation were collected using the medication deviation assessment tool eight weeks after discharge.Patients were categorized into a no medication deviation group and a medication deviation group.Univariate and binomial logistic regression analyses were conducted to identify independent risk factors for post-discharge medication deviation,and a nomogram prediction model was developed.ResultsData were successfully collected from 424 patients,with a response rate of 96.36%(424/440).The incidence of medication deviation was 58.02%(246/424).Binomial logistic regression analysis identified the absence of a fixed caregiver(OR=2.113,P=0.001),large number of comorbid chronic diseases(OR=1.773,P<0.001),medication non-adherence(OR=2.443,P=0.003),and negative coping(OR=2.255,P<0.001)as independent risk factors for medication deviation.A nomogram prediction model based on these four risk factors was constructed.The Hosmer-Lemeshow goodness-of-fit test indicated good calibration(χ2=10.569,P=0.227),with calibration curve closely approximating the ideal line.The area under the receiver operating characteristic curve was 0.770(95%CI:0.584-0.866).ConclusionsThe absence of a fixed caregiver,medication non-adherence,negative coping,and large number of comorbid chronic diseases are independent risk factors for medication deviation in ischemic stroke patients.The nomogram model developed in this study demonstrates good discrimination and accuracy,providing a basis for formulating targeted nursing strategies.

关 键 词：卒中 用药偏差 院外护理 列线图 危险因素 

分 类 号：R473.74[医药卫生—护理学]