血管外科患者手术获得性压力性损伤发生的危险因素分析及预测模型构建

Analysis of risk factors of intraoperatively acquired pressure injury in patients with vascular surgery and its construction of prediction model

目的探讨血管外科患者手术获得性压力性损伤发生的危险因素,并构建预测模型。方法回顾性分析2018年1月—2020年12月于我院血管外科接受手术治疗的1025例患者的临床资料,根据是否发生手术获得性压力性损伤分为损伤组与对照组,对2组患者的性别、年龄、体质量指数及手术时间等临床资料进行单因素分析,差异有统计学意义的单因素代入二元logistic回归分析进行独立危险因素检验,筛选手术获得性压力性损伤的独立危险因素,建立列线图预测模型并验证预测模型的准确性。结果logistic回归分析结果表明,年龄、体质量指数、性别、合并糖尿病、Waterlow评分、潮湿状态、创面冲洗、术中体位变换及血红蛋白水平是血管外科患者发生手术获得性压力性损伤的独立危险因素。建模集和内部验证集的一致性指数分别为0.955和0.970,2组数据模型校准曲线与实际曲线重合良好,2组受试者工作特征曲线下面积分别为0.954和0.969,证明本模型预测精准度较好。结论血管外科患者手术前应充分考虑年龄、体质量指数、性别、糖尿病、Waterlow评分、潮湿状态、创面冲洗、术中体位变换及血红蛋白水平等因素,以期降低患者手术获得性压力性损伤的发生率。

Objective To explore the risk factors of intraoperatively acquired pressure injury(IAPI)in patients with vascular surgery.Methods The clinical data of 1025 patients hospitalized in Department of Vascular Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2018 to December 2020 were retrospectively analyzed.The patients were divided into injury group and control group according to the occurrence of IAPI,and single-factor analysis was used to analyze the clinical data of the two groups,such as gender,age,body mass index,and surgery duration time.The single factors with significant differences between two groups were substituted into binary logistic regression analysis for independent risk factor test so as to screen the independent risk factors of surgically acquired pressure injury,and then nomogram prediction model was established and its accuracy was verified.Results The results of logistic regression showed that age,body mass index,gender,combined with diabetic mellitus,Waterlow score,humid condition,wound irrigation,intraoperative position change,and hemoglobin level were the independent risk factors of IAPI in patients with vascular surgery.The C-index of modeling and internal validation set were 0.955 and 0.970.The correction curves of the two data models were well fitted to the standard curve,and the areas under receiver operating characteristic curve of the two groups were 0.954 and 0.969,repectively,which proved that the prediction accuracy of the model was good.Conclusion Factors such as age,body mass index,gender,diabetic mellitus,Waterlow score,humid condition,wound irrigation,intraoperative position change,and hemoglobin level should be fully considered before operation for vascular surgery patients in order to reduce the incidence of IAPI.