目的 调查老年患者麻醉手术中压力性损伤的发生情况,建立预测风险的列线图模型并进行内部验证。方法 回顾性分析2018-02至2020-08在南充市中心医院进行麻醉手术的老年患者327例。收集麻醉手术中可能发生压力性损伤的因素,根据有无压力性损伤分为两组,比较其差异,并采用多因素Logistic回归分析压力性损伤的影响因素,并建立列线图预测模型进行内部验证。结果 327例都完成了皮肤情况的观察,观察期间共41例(12.53%)出现压力性损伤。通过LASSO回归模型筛选出9个潜在的影响因素,并行多因素Logisitc回归分析,结果显示,年龄、BMI、吸烟史、手术体位、术中变换体位、手术时间、术中低温、白蛋白水平是老年患者麻醉手术中发生压力性损伤的独立性影响因素(P<0.05)。ROC曲线显示模型预测老年患者麻醉手术中发生压力性损伤的AUC为0.926(95%CI:0.888～0.965);校准曲线和H-L拟合优度检验结果显示,该列线图模型预测的概率与实际概率差异无统计学意义(P>0.05)。结论 老年患者麻醉手术中压力性损伤发生率较高,主要受年龄、BMI、吸烟史等因素影响,根据上述因素建立的列线图模型预测麻醉手术中压力性损伤具有较高的准确度与区分度。
Abstract
Objective To investigate the occurrence of pressure ulcer in elderly patients during anesthetic surgery, and to establish a nomogram model to predict the risk and conduct internal verification. Methods A total of 327 elderly patients who underwent anesthetic surgery in Nanchong Central Hospital from February 2018 to August 2020 were selected for retrospective analysis. The factors that might cause pressure ulcer during anesthetic surgery were collected, and the patients were divided into two groups according to whether or not there was pressure ulcer. The differences were compared, and the influencing factors of pressure ulcer were analyzed by multi-factor Logistic regression, and a nomogram prediction model was established for internal verification. Results The skin condition of 327 cases was observed. During the observation period, 41 cases (12.53%) suffered from pressure ulcer. Nine potential influencing factors were screened by LASSO regression model, and multi-factor Logistic regression analysis showed that age, body mass index (BMI), smoking history, special posture during operation, changing posture during operation, operation time, temperature during operation, and albumin level were the independent influencing factors for the occurrence of pressure ulcer during anesthetic surgery in elderly patients (P<0.05). The ROC curve showed that the AUC of the model predicting pressure ulcer during anesthesia in elderly patients was 0.926 (95% CI: 0.888 to 0.965); the results of the calibration curve and the H-L goodness-of-fit test showed that the difference between the probability predicted by the model of the column and the actual probability of the line graph was not statistically significant (P>0.05). Conclusions The incidence of pressure ulcer during anesthesia surgery in elderly patients is relatively high, which is mainly affected by the patient's age, BMI, smoking history and other factors. The nomograph model established according to the above factors is characterized by high accuracy and differentiation in predicting the occurrence of pressure ulcer during anesthesia surgery.
关键词
老年 /
术中 /
压力性损伤 /
多因素分析 /
列线图模型
Key words
aged /
intraoperative /
pressure ulcer /
multi-factor analysis /
nomogram model
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参考文献
[1] 路 璐,李慧芳,张修航,等.压力性损伤的临床研究进展[J].中华保健医学杂志,2020,22(5):558-560.
[2] Chen J,Wang X,Qian H,et al. Correlation between common postoperative complications of prolonged bed rest and quality of Life in hospitalized elderly hip fracture patients [J]. Ann Palliat Med, 2020, 9(3): 1125-1133.
[3] Chen H L,Zhu B,Wei R,et al. A retrospective analysis to evaluate seasonal pressure injury incidence differences among hip fracture patients in a tertiary hospital in East China [J]. Ostomy Wound Manage,2018, 64(2): 40-44.
[4] Lechner A,Kottner J,Coleman S,et al.Outcomes for Pressure Ulcer Trials (OUTPUTs) project:review and classification of outcomes reported in pressure ulcer prevention research[J]. Brit J Dermatol,2021,184(4): 617-626.
[5] 陈哲颖,吴晓蓉,吴梦媛.术中获得性压力性损伤发生的影响因素分析[J].中国护理管理,2019,19(1):52-57.
[6] Taradaj J.Prevention and treatment of pressure ulcers by newest recommendations from European Pressure Ulcer Advisory Panel (EPUAP): practical reference guide for GPs[J]. Fam Med Prim Care Res,2017 (1): 81-83.
[7] Khojastehfar S,Ghezeljeh T N,Haghani S.Factors related to knowledge,attitude,and practice of nurses in intensive care unit in the area of pressure ulcer prevention:a multicenter study[J].J Tissue Viability,2020,29(2):76-81.
[8] Källman U,Hommel A,Borgstedt R M,et al.Pressure ulcer prevalence and prevention interventions-a ten year nationwide survey in Sweden[J].Int Wound J,2022,19(7):1736-1747.
[9] 林晓旭,李 芸,曾志雄,等.全麻下脊柱后路手术患者压疮风险因素分析及预防效果研究[J].中国伤残医学,2021,29(15):13-14.
[10] Araujo S M,Sousa P,Dutra I.Clinical decision support systems for pressure ulcer management:systematic review[J]. JMIR Med Inf,2020,8(10): 21621-21624.
[11] Sprigle S,McNair D,Sonenblum S.Pressure ulcer risk factors in persons with mobility-related disabilities[J]. Adv Skin Wound Care,2020,33(3): 146-154.
[12] Cicceri G,de Vita F,Bruneo D,et al.A deep learning approach for pressure ulcer prevention using wearable computing[J].Hum Cent Comput Info,2020,10(1): 1-21.
[13] Ghorbani V P,Mollaei A,Falakdami A,et al.A systematic review of nurses' practice and related factors toward pressure ulcer prevention[J]. Int Wound J,2023, 20(6): 2386-2401.
[14] Kim J,Lee J Y,Lee E.Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence[J].J Nurs Manage, 2022,30(5):1-9.
[15] VanGilder C A,Cox J,Edsberg L E,et al.Pressure injury prevalence in acute care hospitals with unit-specific analysis: results from the International Pressure Ulcer Prevalence (IPUP) survey database[J].J Wound Ostomy Conti,2021,48(6): 492-503.
[16] Šín P,Hokynková A,Marie N,et al.Machine learning-based pressure ulcer prediction in modular critical care data[J].Diagnostics, 2022, 12(4): 850-855.
[17] Sengul T,Karadag A.Determination of nurses' level of knowledge on the prevention of pressure ulcers:the case of Turkey[J].J Tissue Viability,2020,29(4): 337-341.
[19] Cox J,Edsberg L E,Koloms K,et al.Pressure injuries in critical care patients in US hospitals: results of the International Pressure Ulcer Prevalence Survey[J].J Wound Ostomy Conti, 2022, 49(1): 21.
[20] Moda V B, Moore Z, Patton D,et al. Impaired mobility and pressure ulcer development in older adults: excess movement and too little movement-two sides of the one coin?[J]. J Clin Nurs, 2020, 29(15): 2927-2944.
基金
四川省基层卫生事业发展研究中心资助项目(SWFZ22-Y-19);四川省卫健委科研课题(20PJ298)
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