体外循环心脏手术后患者高氧血症风险因素评估表的构建

Construction of risk factor assessment table for hyperoxemia in patients after cardiopulmonary bypass heart surgery

目的基于德尔菲法构建《体外循环心脏手术后患者高氧血症风险因素评估表》,为临床早期预测及评估心脏手术后患者发生高氧血症的风险提供依据。方法成立课题研究小组,基于体外循环心脏手术的特征,检索各数据库自建库至2022年10月发表的中英文文献并结合相关专业临床医生意见,筛选体外循环心脏手术后患者高氧血症危险因素,拟定《体外循环心脏手术后患者高氧血症风险因素评估表》初稿。采用德尔菲法进行两轮专家函询,对初稿进行补充和完善,最终确立《体外循环心脏手术后患者高氧血症风险因素评估表》终稿。结果根据文献回顾并结合相关专业临床医生意见,建立的《体外循环心脏手术后患者高氧血症风险因素评估表》初稿包含4个维度、21个条目。函询专家共14名,正高级职称5名,副高级职称9名;重症专业6名,心血管外科专业8名。两轮函询问卷的有效回收率分别为100%、85.71%;专家熟悉程度分别为0.81分、0.80分;判断系数分别为0.94、0.92;专家权威系数均为0.86。两轮项目重要性和可操作性的变异系数分别为0.13~0.32和0.11~0.32、0.06~0.26和0.06~0.35;两轮专家函询对项目重要性和可操作性的肯德尔和谐系数(Kendall's W)分别为0.264和0.162、0.258和0.144,差异均有统计学意义(均P<0.05)。经过两轮专家函询的综合评估及筛选,最终确立了《体外循环心脏手术后患者高氧血症风险因素评估表》,包含患者一般资料、既往史、手术相关资料、术后相关资料4个维度共23个条目。结论基于德尔菲法构建的《体外循环心脏手术后患者高氧血症风险因素评估表》具有较高的科学性及可行性,可以为临床评估此类患者发生高氧血症的风险提供参考依据。

Objective To construct Risk factor assessment table for hyperoxemia in patients after cardiopulmonary bypass heart surgery based on Delphi method,providing a basis for early prediction and assessment of the risk of hyperoxemia in patients after cardiac surgery.Methods A research team was established.Based on the characteristics of extracorporeal circulation cardiac surgery,the Chinese and English literature published by each database until October 2022 was retrieved and the opinions of relevant professional clinicians were combined to screen the risk factors of hyperoxemia in patients after cardiopulmonary bypass heart surgery,and the preliminary draft of the Risk factor assessment table for hyperoxemia in patients after cardiopulmonary bypass heart surgery was drawn up.The Delphi method was used to conduct two rounds of expert letter consultation to supplement and improve the initial draft and finally established the final draft of the Risk factor assessment table for hyperoxemia in patients after cardiopulmonary bypass heart surgery.Results The preliminary draft of the Risk factor assessment table for hyperoxemia in patients after cardiopulmonary bypass heart surgery was constructed according to the literature review and the opinions of relevant professional clinicians,which contained 4 dimensions and 21 items.A total of 14 experts were consulted by letter,including 5 senior titles and 9 associate senior titles.Six of them major in critical care and the other eight major in cardiovascular surgery.The effective response rates for the two rounds of questionnaire surveys were 100%and 85.71%,expert familiarity levels were 0.81 and 0.80,judgment coefficients were 0.94 and 0.92,respectively.Expert authority coefficients were both 0.86.Coefficients of variation for the importance and feasibility items in the two rounds ranged from 0.13 to 0.32 and 0.11 to 0.32,0.06 to 0.26 and 0.06 to 0.35,respectively.The Kendall's W for importance and feasibility in the two rounds were 0.264 and 0.162,and 0.258 and 0.144 respectively,indicating statistically significant(all P<0.05).After two rounds of expert consultations,a comprehensive evaluation and selection process resulted in the final establishment of the Risk factor assessment table for hyperoxemia in patients after cardiopulmonary bypass heart surgery,consisting of 4 dimensions and 23 items,which included general data,past history,operation-related data and postoperative data.Conclusion The Risk factor assessment table for hyperoxemia in patients after cardiopulmonary bypass heart surgery based on the Delphi method is highly scientific and feasible,which can provide reference for clinical assessments of the risk of hyperoxemia in such patients.