床旁超声对ICU成人患者骶尾部压力性损伤的预测价值

The predictive value of bedside ultrasonography for pressure injury in sacral caudal of adult patients in intensive care units

目的探究骶尾部皮下组织厚度、肌肉回声减弱、皮下浅筋膜连续性、皮下低回声损伤、层次结构不清、左室射血分数6个床旁超声指标对ICU成人骶尾部压力性损伤预测价值,为选择适合ICU患者的压力性损伤预测工具提供理论依据。方法使用巢式病例对照研究的方法,选择2022年1月-6月入住新疆乌鲁木齐市某医院ICU的成人患者为研究对象。观察7天,发生压力性损伤的研究对象为压力性损伤组,以年龄、性别为匹配条件,按1:3匹配未发生压力性损伤的研究对象为非压力性损伤组。筛选有预测价值的超声指标,并分别使用超声指标与Braden量表预测ICU患者压力性损伤,评价其预测能力。结果符合纳排标准的患者56例,压力性损伤组14例,非压力性损伤组42例。Logistic回归分析显示骶尾部皮下组织厚度、层次结构不清、左室射血分数与压力性损伤密切相关(OR=0.019,33.008,0.787;P=0.004,0.002,0.004)。运用骶尾部皮下组织厚度、层次结构不清、左室射血分数及Braden量表预测ICU患者骶尾部压力性损伤,受试者工作特征分析显示四者曲线下面积分别为0.796、0.814、0.912、0.702;敏感度分别为60%、70%、90%、70%;特异度分别为83.3%、92.9%、88.1%、73.8%;约登指数分别为0.433、0.629、0.781、0.438。结论骶尾部皮下组织厚度、层次结构不清、左室射血分数与ICU患者压力性损伤密切相关,三者预测效能明显优于Braden量表,是ICU成人患者骶尾部压力性损伤可靠的预测指标。

Objective To investigate the predictive value of six ultrasound indicators for pressure injury in sacral caudal of adult patients in intensive care units(ICU),including subcutaneous tissue thickness,discontinuous subcutaneous superficial fascia,subcutaneous hypoechoic injury,unclear layer structure,and left ventricular ejection fraction,which aims to provide reliable predictive methods of pressure injury for patients in ICU.Methods Adult patients admitted to ICU in a hospital in Urumqi,Xinjiang from January to March 2022 were eligible for the candidates for this nested case-control study.A seven-day period was set to observe the occurrence of pressure injury.Patients with pressure ulcers were put into the pressure ulcers group(case group),and each individual of the case group matched with three patients without pressure ulcers according to gender and age.To evaluate the predictive value of ultrasonic indicators,we compared the area under the curve of the receiver operating characteristic analysis,sensitivity and specificity of ultrasonic indicators and braden scale to evaluate the predictive value of pressure injury of ultrasonic indicators.Results 42 patients developed pressure injury in ICU and 126 patients who had no pressure injury were divided into the non-pressure injury group.Logistic regression analysis demonstrated that subcutaneous tissue thickness,unclear layer structure and left ventricular ejection fraction were closely related to pressure injury(OR=0.019,30.333,0.796;P=0.008,<0.001,<0.001).The subcutaneous tissue thickness of the sacral region,unclear layer structure,left ventricular ejection fraction and Braden scale were used to predict pressure injury in sacral region of ICU patients.Receiver operating characteristics analysis showed that the areas under the curve of these four methods were 0.796,0.814,0.912 and 0.702,respectively.The sensitivity of these four indicators were 60%,70%,90%and 70%,respectively.The specificity of these four indicators were 83.3%,92.9%,88.1%,73.8%,respectively.Youdon index were 0.433,0.629,0.781,0.438 respectively.Conclusion The subcutaneous tissue thickness,unclear layer structure and left ventricular ejection fraction were closely related to pressure injury in ICU patients,and these three ultrasonic indicators were appropriate to predict the occurrence of the pressure injury in sacral region of critical illness patients compared to Braden scale.