冠脉旁路移植术后ICU转出患者压力性损伤风险评估与影响因素分析

Risk assessment and influencing factors of pressure injury in patients transferred from ICU after coronary artery bypass grafting

目的探讨冠脉旁路移植术(CABG)患者术后转出ICU时压力性损伤(PI)高风险的发生情况并分析其影响因素。方法采用便利抽样法,选取2018年1月—2019年6月在北京安贞医院心血管外科由ICU转入普通病房的277例因冠心病行CABG术或CABG术合并瓣膜置换术的患者为研究对象,采用一般资料调查表、Morse跌倒风险评估量表、日常生活自理能力Barthel指数评估量表、Waterlow评分量表对患者进行调查,评估PI高风险发生情况。采用Logistic回归分析探讨CABG术后PI发生高风险的影响因素。结果14.4%(40/277)的CABG患者为术后PI高风险。多因素Logistic回归分析显示,日常生活自理能力评分(OR=0.951,95%CI:0.909~0.995,P=0.031)、年龄(OR=1.151,95%CI:1.075~1.234,P<0.001)、B型脑钠肽(OR=11.038,95%CI:2.263~53.826,P=0.003)、BMI(OR=1.366,95%CI:1.178~1.585,P<0.001)、射血分数(OR=0.938,95%CI:0.883~0.998,P=0.042)、手术时间(OR=1.912,95%CI:1.137~3.216,P=0.015)是CABG术后发生PI高风险的影响因素。结论多种因素与CABG患者术后PI高风险呈独立相关,临床护理人员应重视其危险因素,尽早采取预防措施。

Objective To investigate the occurrence and influencing factors of high risk of pressure injury(PI)in patients transferred from ICU after coronary artery bypass grafting(CABG).Methods From January 2018 to June 2019,the convenient sampling method was used to select 277 patients with coronary heart disease who were transferred from ICU to general ward in Cardiovascular Surgery Department of Beijing Anzhen Hospital and underwent CABG or CABG combined with valve replacement as the research objects.The general information questionnaire,Morse Fall Scale(MFS),Barthel Index of activities of daily living and Waterlow Score Scale were used to investigate the patients to evaluate the occurrence of high risk of PI.Logistic regression analysis was used to explore the influencing factors of high risk of PI after CABG.Results A total of 14.4%(40/277)of CABG patients were at high risk of postoperative PI.Multivariate Logistic regression analysis showed that activities of daily living score(OR=0.951,95%CI:0.909-0.995,P=0.031),age(OR=1.151,95%CI:1.075-1.234,P<0.001),B-type brain natriuretic peptide(OR=11.038,95%CI:2.263-53.826,P=0.003),BMI(OR=1.366,95%CI:1.178-1.585,P<0.001),ejection fraction(OR=0.938,95%CI:0.883-0.998,P=0.042)and operation time(OR=1.912,95%CI:1.137-3.216,P=0.015)were the influencing factors of high risk of PI after CABG.Conclusions A variety of factors are independently related to the high risk of postoperative PI in CABG patients,and clinical nurses should pay attention to the risk factors and take preventive measures as soon as possible.