肢体肌力等级及Braden量表评分对老年呼吸衰竭机械通气患者压力性损伤的预测价值  

Predictive value of limb muscle strength grades and Braden scale scores for pressure injuries in elderly mechanically ventilated patients with respiratory failure

作　　者：刘畅[1] 张银萍[1] 周立杰[1] 马宝静 蔡娟[1] 陈茜茜 张玉萍[1] Liu Chang;Zhang Yinqing;Zhou Lijie;Ma Baojing;Cai Juan;Chen Qianqian;Zhang Yuping(Department of Respiratory and Critical Care Medicine,Jiangsu Province Hospital,Nanjing 210029,China)

机构地区：[1]江苏省人民医院呼吸与危重症医学科,南京210029

出　　处：《保健医学研究与实践》2024年第12期127-132,共6页Health Medicine Research and Practice

基　　金：江苏省卫生健康委员会老年健康科研项目(LKM2022002)。

摘　　要：目的探讨肢体肌力等级及Braden量表评分对老年呼吸衰竭机械通气患者发生压力性损伤(PI)的预测价值。方法选取2018年1月—2023年11月江苏省人民医院收治的312例老年呼吸衰竭机械通气患者为研究对象,根据PI的发生情况分为PI组(n=11)和非PI组(n=301)。比较2组患者的临床资料、肢体肌力等级及Braden量表评分,采用多因素logistic回归分析老年呼吸衰竭机械通气患者发生PI的影响因素,采用受试者工作特征(ROC)曲线分析肢体肌力等级及Braden量表评分对患者发生PI的预测价值。结果全部312例老年呼吸衰竭机械通气患者均顺利救治成功,住院期间共发生11例PI,发生率为3.5%,均为1期,经过积极治疗后均痊愈出院。PI组患者的年龄、身体质量指数、糖尿病史占比、血C反应蛋白水平、白细胞计数、急性生理与慢性健康评分显著高于非PI组,血白蛋白、血红蛋白水平、氧合指数、肢体肌力等级、Braden量表评分显著低于非PI组,差异有统计学意义(P<0.05)。多因素logistic回归分析表明,糖尿病史、肢体肌力等级与Braden量表评分是老年呼吸衰竭机械通气患者PI发生的独立影响因素(P<0.05)。ROC曲线分析表明,肢体肌力等级与Braden量表及二者联合应用模型对PI发生具有较高预测价值。结论糖尿病史、肢体肌力等级及Braden量表评分是老年呼吸衰竭机械通气患者发生PI的独立影响因素。肢体肌力等级及Braden量表评分联合评估可进一步提高对患者PI发生风险的预测价值。临床上应加强对高危患者的监测,从而采取针对性干预措施,以减少PI的发生。Objective To assess the predictive value of limb muscle strength grades and Braden scale scores for pressure injuries(PI)in elderly mechanically ventilated patients with respiratory failure.Methods From January 2018 to November 2023,312 elderly mechanically ventilated patients with respiratory failure admitted to our hospital were assigned to PI(n=11)and non-PI(n=301)groups based on PI occurrence.Clinical data,limb muscle strength grades,and Braden scale scores were com-pared between groups.Multivariate logistic regression was used to identify risk factors for PI,and Receiver Operating Charac-teristic(ROC)curves were adopted to evaluate the predictive value of limb muscle strength grades and Braden scale scores.Re-sults All 312 patients were successfully treated,with 11 developing PI(3.5%),all stage 1,and all cured.The PI group had significantly higher age,body mass index(BMI),diabetes history,C-reactive protein(CRP)levels,white blood cell count,and Acute Physiology and Chronic Health EvaluationⅡscores,and significantly lower albumin,hemoglobin,oxygenation in-dex,limb muscle strength grades,and Braden scale scores than the non-PI group(P<0.05).Multivariate logistic regression showed that diabetes history,limb muscle strength grades,and Braden scale scores were independent risk factors for PI(P<0.05).ROC curve analysis indicated that limb muscle strength grades,Braden scale scores,and their combined model had high predictive value for PI.Conclusion Diabetes history,limb muscle strength grades,and Braden scale scores are independent risk factors for PI in elderly patients on mechanical ventilation with respiratory failure.Combined assessment of limb muscle strength grades and Braden scale scores promotes PI prediction.Clinically,high-risk patients should be closely monitored,and targeted interventions implemented to reduce PI incidence.

关 键 词：压力性损伤 肢体肌力等级 Braden量表评分 预测价值 老年患者 呼吸衰竭 机械通气 

分 类 号：R563.8[医药卫生—呼吸系统] R473.6[医药卫生—内科学]