妇科手术患者医院获得性压疮风险评分工具的研制

卢婷婷; 王艳; 张颖慧

doi:10.16766/j.cnki.issn.1674-4152.003778

妇科手术患者医院获得性压疮风险评分工具的研制

doi: 10.16766/j.cnki.issn.1674-4152.003778

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

基金项目:

安徽省科学研究重点项目 2022AH051536

详细信息

通讯作者:
卢婷婷，E-mail：286237072@qq.com

中图分类号: R473.71
计量
- 文章访问数: 17
- HTML全文浏览量: 10
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2023-12-06
- 网络出版日期: 2024-12-31

Development of a risk scoring tool for hospital-acquired pressure ulcer in gynecological surgery patients

1.
Department of Obstetrics, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

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。
- 医院获得性压疮 /
- 妇科肿瘤 /
- 压疮风险因素 /
- 预测模型
Abstract: 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.
- Hospital-acquired pressure ulcers /
- Gynecological tumors /
- Risk factors for pressure ulcers /
- Prediction model

HTML全文

图 1 HAPU风险预测模型“SPURS”

注：虚线表示理想的预测曲线，点线表示从原始样品得到的实际曲线，实线表示重新取样得到的偏倚校正曲线。

Figure 1. HAPU risk prediction model: "SPURS"

下载: 全尺寸图片幻灯片

图 2 2组SPURS评分点图

Figure 2. Two sets of SPURS rating point charts

下载: 全尺寸图片幻灯片

表 1 妇科手术患者基线资料特征与压疮风险的单因素分析

Table 1. Univariate analysis of baseline characteristics and pressure ulcer risk in patients

项目	观察组(n=64)	对照组(n=64)	统计量	P值
年龄[例(%)]			12.522^a	< 0.001
≥70岁	27(42.19)	9(14.06)
＜70岁	37(57.81)	55(85.94)
BMI[例(%)]			7.173^a	0.007
< 23	35(54.69)	20(31.25)
≥23	29(45.31)	44(68.75)
吸烟史[例(%)]			0.237^a	0.626
是	9(14.06)	11(17.19)
否	55(85.94)	53(82.81)
ASA分级[例(%)]			21.460^a	< 0.001
1~2级	15(23.44)	41(64.06)
≥3级	49(76.56)	23(35.94)
术前Braden评分[例(%)]			6.893^a	0.009
≤14分	16(25.00)	5(7.81)
≥15分	48(75.00)	59(92.19)
病理类型[例(%)]			2.723^a	0.099
急诊	28(43.75)	19(29.69)
择期	36(56.25)	45(70.31)
疾病类型[例(%)]			2.594^a	0.628
畸胎瘤	20(31.25)	25(39.06)
子宫肌瘤	18(28.13)	20(31.25)
巧克力囊肿	24(37.50)	16(25.00)
宫颈癌	1(1.56)	1(1.56)
子宫内膜癌	1(1.56)	2(3.13)
贫血[例(%)]	10(15.63)	1(1.56)	8.056^a	0.005
糖尿病[例(%)]	20(31.25)	14(21.88)	1.442^a	0.230
心脏病[例(%)]	17(26.56)	8(12.50)	4.026^a	0.045
高血压[例(%)]	38(59.38)	22(34.38)	8.031^a	0.005
中风[例(%)]	2(3.13)	1(1.56)	< 0.001^a	0.999
血管疾病[例(%)]	7(10.94)	3(4.69)	1.736^a	0.188
神经系统疾病[例(%)]	0	1(1.56)		0.999^c
呼吸道疾病[例(%)]	8(12.50)	1(1.56)	4.303^a	0.038
ICU停留[例(%)]	12(18.75)	10(15.62)	0.220^a	0.639
住院时间[M(P₂₅, P₇₅)，d]	13.14(12.00, 14.50)	5.11(4.00, 6.00)	-9.787^b	< 0.001
注：^a为χ²值，^b为Z值，^c为采用Fisher精确检验。

下载: 导出CSV

表 2 HAPU的二元多因素logistic回归分析

Table 2. Binary multivariate logistic regression analysis of HAPU

变量	B	SE	Waldχ²	P值	OR值	95% CI	指定分数
年龄≥70岁	0.631	0.263	6.519	0.011	1.956	1.169~3.273	2
住院时间	0.697	0.125	4.249	0.039	2.007	1.035~3.893	1
ASA等级≥3级	1.453	0.354	16.837	< 0.001	4.277	2.136~8.563	2
BMI < 23	0.616	0.291	5.388	0.020	1.851	1.101~3.113	1
术前Braden评分≤14	0.671	0.236	7.149	0.027	1.879	1.183~2.985	2
贫血	0.955	0.293	10.654	0.001	2.599	1.465~4.611	2
呼吸道疾病	2.305	1.027	5.036	0.025	10.029	1.339~75.112	3
高血压	0.393	0.142	5.626	0.018	1.481	1.071~2.050	1

下载: 导出CSV

参考文献(22)

[1]	KARAHAN E, AYRI A U, ÇELIK S. Evaluation of pressure ulcer risk and development in operating rooms[J]. J Tissue Viability, 2022, 31(4): 707-713. doi: 10.1016/j.jtv.2022.09.001
[2]	池清华, 黄燕红, 丁玉兰. 基于JCI标准对某院压疮现患率和压疮发生率的调查分析[J]. 中国卫生标准管理, 2017, 8(21): 22-24. CHI Q H, HUANG Y H, DING Y L. Survey on prevalence of pressure ulcer and hospital-acquired pressure ulcer based on the JCI standard[J]. China Health Standard Management, 2017, 8(21): 22-24.
[3]	DÍAZ-CARO I, GARCÍA GÓMEZ-HERAS S. Incidence of hospital-acquired pressure ulcers in patients with "minimal risk" according to the "Norton-MI" scale[J]. PLoS One, 2020, 15(1): e0227052. DOI: 10.1371/journal.pone.0227052.
[4]	韩晶. 压疮风险预警护理模式在预防重症脑梗死住院患者压疮发生中的应用价值[J]. 中文科技期刊数据库(全文版)医药卫生, 2022(5): 179-181. HAN J. Application value of pressure ulcer risk warning nursing model in preventing the occurrence of pressure ulcer in hospitalized patients with severe cerebral infarction[J]. Chinese Science and Technology Journal Database (full-text version) Medicine Health, 2022(5): 179-181.
[5]	李阳, 祁进芳, 董正惠, 等. Braden量表和Scott triggers量表在ICU老年髋关节置换术患者压力性损伤中的应用研究[J]. 中国医药导报, 2022, 19(14): 171-174, 179. LI Y, QI J F, DONG Z H, et al. Application study of Braden scale and Scott triggers scale in ICU elderly patients undergoing hip arthroplasty with pressure injury[J]. China Medical Herald, 2022, 19(14): 171-174, 179.
[6]	HUANG C, MA Y X, WANG C X, et al. Predictive validity of the braden scale for pressure injury risk assessment in adults: a systematic review and meta-analysis[J]. Nurs Open, 2021, 8(5): 2194-2207. doi: 10.1002/nop2.792
[7]	KENNERLY S M, SHARKEY P D, HORN S D, et al. Nursing assessment of pressure injury risk with the braden scale validated against sensor-based measurement of movement[J]. Healthcare (Basel), 2022, 10(11): 2330. DOI: 10.3390/healthcare10112330.
[8]	ALOWENI F, ANG S Y, FOOK-CHONG S, et al. A prediction tool for hospital-acquired pressure ulcers among surgical patients: surgical pressure ulcer risk score[J]. Int Wound J, 2019, 16(1): 164-175. doi: 10.1111/iwj.13007
[9]	KOTTNER J, CUDDIGAN J, CARVILLE K, et al. Pressure ulcer/injury classification today: an international perspective[J]. J Tissue Viability, 2020, 29(3): 197-203. doi: 10.1016/j.jtv.2020.04.003
[10]	于石成, 亓晓, 胡跃华, 等. 多变量回归模型分析应用概述[J]. 中华预防医学杂志, 2019, 53(3): 334-336. YU S C, QI X, HU Y H, et al. Overview of multivariate regression model analysis and application[J]. Chinese Journal of Preventive Medicine, 2019, 53(3): 334-336.
[11]	吴传飞, 余佩, 宣传富. 婴幼儿呼吸道合胞病毒中-重度感染的预测模型构建与验证[J]. 新医学, 2023, 54(8): 574-579. WU C F, YU P, XUAN C F. Establishment and validation of a predictive model for moderate and severe respiratory syncytial virus infection in infants[J]. Journal of New Medicine, 2023, 54(8): 574-579.
[12]	EVERETT DAY S, KOIRALA B, MCILTROT K. Repositioning strategies to prevent pressure injuries in the ICU: integrative review on implementation factors[J]. Adv Skin Wound Care, 2022, 35(6): 344-351. doi: 10.1097/01.ASW.0000821772.03685.77
[13]	穆晓川. 手术室改良体位护理对长时间侧卧位患者压疮及舒适度的影响[J]. 山西医药杂志, 2021, 50(8): 1341-1343. MU X C. Effect of modified position nursing on pressure ulcer and comfort of patients with lateral position for a long time in operating Room[J]. Shanxi Medical Journal, 2021, 50(8): 1341-1343.
[14]	张丽, 董哲, 秦玉慧, 等. 伤口造口患者压疮的影响因素研究[J]. 北京医学, 2021, 43(7): 702-704, 708. ZHANG L, DONG Z, QIN Y H, et al. Influencing factors of pressure ulcer in wound stoma patients[J]. Beijing Medical Journal, 2021, 43(7): 702-704, 708.
[15]	刘佳, 姜海, 王银娥, 等. 探析重症监护室患者压疮易发的危险因素及Apache Ⅱ评分对压疮的预测价值分析[J]. 中国现代药物应用, 2021, 15(12): 93-95. LIU J, JIANG H, WANG Y E, et al. Analysis of the risk factors of pressure ulcers in intensive care unit patients and the predictive value of ApacheⅡscore for pressure ulcers[J]. Chinese Journal of Modern Drug Application, 2021, 15(12): 93-95.
[16]	陈慧玲, 王淑东. Waterlow压力性损伤量表与Braden压力性量表在预测ICU病人压疮预防中的价值[J]. 蚌埠医学院学报, 2020, 45(8): 1107-1109, 1113. CHEN H L, WANG S D. Value of the Waterlow stress injury scale and Braden stress scale in predicting the prevention of pressure ulcer in ICU patients[J]. Journal of Bengbu Medical College, 2020, 45(8): 1107-1109, 1113.
[17]	MEYER A C, EKLUND H, HEDSTRÖM M, et al. The ASA score predicts infections, cardiovascular complications, and hospital readmissions after hip fracture: a nationwide cohort study[J]. Osteoporosis Int, 2021, 32(11): 2185-2192. doi: 10.1007/s00198-021-05956-w
[18]	WRIGHT K M, VAN NETTEN Y, DORRINGTON C A, et al. Pressure injury can occur in patients undergoing prolonged head and neck surgery[J]. J Oral Maxillofac Surg, 2014, 72(10): 2060-2065. doi: 10.1016/j.joms.2014.04.018
[19]	胡敏, 王娟, 张代英, 等. 基于皮肤微环境干预措施对结直肠癌患者术中获得性压力性损伤的影响[J]. 河北医药, 2023, 45(6): 865-868. HU M, WANG J, ZHANG D Y, et al. Effect of skin microenvironment-based nursing on intraoperative acquired pressure injury in patients with colorectal cancer[J]. Hebei Medical Journal, 2023, 45(6): 865-868.
[20]	GAULKE C A, SHARPTON T J. The influence of ethnicity and geography on human gut microbiome composition[J]. Nat Med, 2018, 24(10): 1495-1496. doi: 10.1038/s41591-018-0210-8
[21]	马红珍, 耿兰坤, 耿彦玲, 等. 急性脑卒中患者营养不良, 卒中后并发症的危险因素分析[J]. 现代消化及介入诊疗, 2019, 24(A01): 658-659. MA H Z, GENG L K, GENG Y L, et al. Risk factors of malnutrition and post-stroke complications in patients with acute stroke[J]. Modern Interventional Diagnosis and Treatment in Gastroenterology, 2019, 24(A01): 658-659.
[22]	于杰, 孙忠人, 李洪玲, 等. 艾灸对压疮大鼠创面局部平均血流灌注量影响[J]. 辽宁中医药大学学报, 2019, 21(9): 90-96. YU J, SUN Z R, LI H L, et al. Effect of moxibustion on local average blood flow perfusions of wounds in rats with pressure ulcers[J]. Journal of Liaoning University of Traditional Chinese Medicine, 2019, 21(9): 90-96.