骨科老年患者呼吸道梗阻风险评估体系的构建及初步验证

Development and validation of an indicator set to assess airway obstruction risk in elderly orthopedic patients

目的构建骨科老年患者呼吸道梗阻风险评估体系,早期识别高风险人群。方法通过文献检索和小组讨论,拟定评估体系的初级指标,通过2轮专家咨询确定最终指标,并对指标进行初步验证。结果构建的风险评估体系由年龄、意识状态、咳痰能力、痰液黏稠度、疼痛程度、可行体位、手术(受伤)部位、麻醉方式、基础疾病及高危因素10个指标构成。指标重要性赋值均数为4.00~5.00,变异系数为0~0.17。应用该评估体系对186例骨科老年患者进行评估,共发生呼吸道梗阻4例(风险评估2级1例,3级2例,4级1例)。结论骨科老年患者呼吸道梗阻风险评估体系具有科学性、可靠性及临床实用性,可早期识别高风险人群,降低呼吸道梗阻发生率。

Objective To develop a scientific and practical risk assessment system for airway obstruction in elderly orthopedic patients and to identify the high-risk patient as early as possible.Methods The draft version of risk assessment system was formulated after literature retrieval and group discussion,then two rounds of expert consultation were conducted to determine the final version of the indicators.The indicators were validated in 186 elderly orthopedic patients.Results The risk assessment system included 10 indicators:age,consciousness,sputum expectoration,sputum viscosity,pain severity,feasible body position,surgical(injury)site,anesthesia method,basic disease and high-risk factors.Importance of the indicator scored 4-5 points,with the coefficient of variation ranging from 0 to 0.17.Among 186 patients,4 patients developed airway obstruction(1 at grade 2 risk,2 at grade 3 risk,and 1 at grade 4 risk).Conclusion The risk assessment system for airway obstruction in elderly orthopedic patients is scientific,reliable and practical,which can achieve early identification of high-risk patient and reduce the incidence of airway obstruction.