心血管疾病早期预警评分量表的构建与应用

Development and application of the Cardiovascular Early Warning Scale

目的 探讨精准护理视角下心血管系统疾病早期预警的量化评估方法.方法 在前期研究的基础上结合改良早期预警评分,参考国内外心血管系统疾病风险预测模型,形成心血管疾病早期预警评分量表条目池;采用专家小组讨论法对条目池和指标赋分进行修订和调整,形成心血管疾病早期预警评分初表;采用量表对1067例住院患者进行测试,判断量表的预测效能,确定危险程度分值划分范围,形成最终量表,并评价心血管疾病早期预警评分量表的信效度.结果 最终形成的心血管疾病早期预警评分量表包括收缩压、心率、呼吸、血氧饱和度、心律失常、体温、意识、疼痛评分、年龄共9个条目,O/E值为0.80-0.91,Pearson相关系数为0.954（P〈0.05）,总分为0-25分,低危组（0-3分）,中危组（4-6分）,高危组（7-10分）,极高危组（≥11分）;量表的内部一致性信度Cronbach＇sα系数为0.730,结构效度中采用主成分分析法共提取出特征值〉1的公因子3个,3个公因子的累积贡献率为65.866％;校标关联效度中量表的评估值与标准值的Pearson相关系数为0.947（P〈0.05）.结论 心血管疾病早期预警评分量表使用简单快捷,符合测量学要求,可为临床护理人员对心血管疾病患者的护理决策提供评判依据.

Objective To explore the method for quantitatively assessing cardiovascular early warning from the perspective of precision nursing. Methods The original item pool for the Cardiovascular Early Warning Scale （CEWS） was buih with reference to the prediction models for cardiovascular diseases at home and abroad on the basis of early research combined with the modified early warning scale ; the item pool and scores assigned to each indicator were revised and adjusted by panel discussion, hence the original CEWS; and the scale was used to test 1 067 hospitalized patients to assess its prediction effect, define the range of danger level and form the final scale. The reliability and validity of CEWS was then assessed. Results The final version of CEWS included 9 items, namely, systolic pressure, heart rate, breath, blood oxygen saturation, arrhythmia, body temperature, consciousness, pain score and age. O/E value was 0.80-0.91, Pearson coefficient was 0.954 （P 〈 0.05）, total score was 0-25, including the low-risk group （0-3）, the mid-risk group （4-6）, the high-risk group （7-10） and the extreme-risk group （i〉 11）. Cronbach＇s c- , an indicator showing the reliability in the scale＇s internal consistency, was 0.730. Totally 3 common factors whose characteristic value was 〉 1 were extracted by principal component analysis in structural validity, which accounted for 65.866% accumulatively. The Pearson coefficient between the scale＇s assessed value and the standard value in criterion correlation validity was 0.947 （P 〈 0.05）. Conclusions CEWS is easy and convenient for use and conforms to the requirements of metrology, which can offer a basis for clinical staff to make nursing decisions for cardiovascular diseases.