ICU颅脑损伤术后患者便秘风险预测模型的构建

Construction of constipation risk prediction model for patients in ICU after craniocerebral injury

目的:探讨ICU颅脑损伤术后患者便秘发生的风险因素,并建立有效的发生风险预测模型,为指导ICU临床护理工作提供参考依据。方法:收集2012年3月至2017年9月在郑州市中医院治疗的433例颅脑损伤术后患者的临床资料,通过logistic回归分析构建便秘发生的风险预测模型,并通过实际调查验证模型的临床判断能力。结果:共有6项风险因素纳入ICU颅脑损伤术后患者便秘风险的预测模型,便秘的发生概率P=1/(1+e^(-Y)),Y=.12.926+1.610×A(有便秘史)+1.725×B(最低收缩压<70 mmHg)+3.146×C(有使用镇静麻醉药)+2.168×D(有使用升压药)+1.985×E(MV天数)+1.133×F(GCS评分)。通过对比预测模型评分与实际便秘发生情况进行可知,在评分>8时便秘的发生风险较高。结论:便秘史、最低收缩压、使用镇静麻醉药、使用升压药、MV天数和GCS评分对ICU颅脑损伤术后患者便秘的发生具有良好的预测价值,临床医护人员应注意加强评估并实施预防性的护理干预。

Objective： To explore the risk factors of postoperative constipation for patients in ICU after craniocerebral injury, and establish an effective risk prediction model, so as to provide reference for guiding ICU clinical nursing work. Methods： The clinical data of 433 patients with craniocerebral injury treated in our hospital from March 2012 to September 2017 were collected, and the risk prediction model of constipation was constructed by Logistic regression analysis. The clinical judgement ability of the model was verified by actual investigation. Results： A total of six risk factors were included in the prediction model of constipation risk in patients with ICU after craniocerebral injury. The occurrence probability of constipation is P=1/（1＋e^-Y）, Y=-12.926＋1.610×A（having constipation history） ＋ 1.725×B（systolic blood pressure 70 mm Hg） ＋3.146×C（having used sedative anesthetics） ＋2.168×D（having used vasopressor drugs） ＋1.985×E [mechanical ventilation（MV） days] ＋1.133×F [Glasgow Coma Scale（GCS） score]. According to the comparison between the prediction model score and the actual constipation, the risk of constipation was higher when the score was 8. Conclusion： History of constipation, systolic blood pressure, use of sedative drugs, use of vasopressors, MV days and GCS score for ICU patients with constipation after craniocerebral injury surgery have good predictive value, clinical staff should pay attention to strengthening the evaluation and implementation of preventive nursing intervention.