基于护理模式的机械通气患儿谵妄列线图预测模型构建

Construction of delirium nomogram prediction model for children with mechanical ventilation based on nursing model

目的:构建基于机械通气患儿发生谵妄的列线图预测模型,为制定相应护理措施提供指导。方法:选取2021年7月-2023年7月166例住院机械通气患儿作为研究对象,开展回顾性分析,根据护理模式的不同划分为综合护理组(95例)和常规护理组(71例)。收集所有机械通气患儿谵妄发生率情况,研究探讨影响机械通气患儿谵妄发生的单因素、多因素情况并构建列线图模型和验证。结果:166例患儿中有48例发生谵妄,其中综合护理组21例,常规护理组27例,不同护理模式下谵妄发生率差异显著,具有统计学意义(χ^(2)=5.012,P=0.025)。COX风险模型多因素回归结合列线图模型绘制,影响机械通气患儿发生谵妄的因素为机械通气时间、PICU住院时长、人工气道建立方式、睡眠障碍、右美托咪定、APACHEⅡ评分、护理模式、是否合并感染,14 d的发生谵妄风险在0.75~0.85,ROC曲线验证的AUC为0.902。结论:机械通气患儿发生谵妄受到多种因素影响,包括机械通气时间、人工气道建立方式、睡眠障碍等,临床可根据患儿实际情况采用综合护理进行干预,促进患儿早日康复。

Objective:To study the development of corresponding nursing measures based on the nomogram prediction model for delirium in children with mechanical ventilation.Methods:A total of 166 hospitalized children with mechanical ventilation from July 2021 to July 2023 were selected as the research subjects for retrospective analysis.They were divided into a comprehensive nursing group(95 cases,comprehensive nursing)and a routine nursing group(71 cases,routine nursing)based on different nursing modes.The incidence of delirium in all samples of mechanical ventilation children was collected,to study single factors and multi-factors in mechanical ventilation children,and construct and verify the nomogram model.Results:There were 48 cases of delirium among 166 children,including 21 cases in the comprehensive nursing group and 27 cases in the routine nursing group.The incidence of delirium under different nursing modes was significantly statistically different,with(χ^(2)=5.012,P=0.025).The COX risk model was developed using multivariate regression combined with a column chart model.The order of influence on delirium occurrence in mechanical ventilation children was mechanical ventilation time,PICU length of stay,artificial airway establishment method,sleep disorders,dexmedetomidine,APACHE II score,nursing mode,and co-infection.The 14-day risk of delirium was between 0.75-0.85,and the AUC of ROC curve verification was 0.902.Conclusions:The occurrence of delirium in children with mechanical ventilation is affected by many factors,including mechanical ventilation time,artificial airway establishment method,sleep disorders,etc.In clinical practice,comprehensive nursing interventions can be adopted based on the actual situation of the children to promote their early recovery.