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由于ICU病人的特殊性,一般需较长时间卧床休息,其压疮的发生率也显著高于普通病房;有数据显示,在ICU病人中,压疮发生率为1%~56%[1]。压疮因局部组织受长期力的作用,致使部分组织血液循环障碍,并导致组织细胞的坏死[2]。压疮的发生,在增加病人额外痛苦和经济负担外,严重者会累及筋骨,若处理或发生时机不当,则会增加病人住院时间和死亡率;且我国已将压力性损伤作为评价医院等级护理质量指标之一,因此,及时预防显得十分必要[3-4]。但是,对于ICU病人均行压疮预防,会造成人力的大量浪费;因此,能够快速、准确筛选出潜在压疮病人,并提供护理措施,则会提高护理质量。针对压疮风险,国内外已建立多种压力性损伤量表,但各种量表在人群中应用的效果差异较大,目前国内外研究领域尚无统一的普遍适用性量表[5]。基于此,本文就我院ICU病房的724例病人进行研究,比较Waterlow量表与Braden量表的预测价值,现将研究结果作一报道。
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在724例观察对象中,实际发生压疮的有44例,发生率为6.07%,其中Ⅰ期10例、Ⅱ期34例,未见Ⅲ期及其以上压疮。
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在Braden评分量表中,真阳性为44例,真阴性为178例;Waterlow评分量表中,真阳性44例,真阴性600例(见表 1)。
是否发生压疮 Braden评分量表 Waterlow评分量表 高风险 低风险 高风险 低风险 是 44(6.08) 0(0.00) 44(6.08) 0(0.00) 否 502(69.34) 178(24.59) 80(11.05) 600(82.87) 表 1 2种评分与实际压疮比较[n; 百分率(%)]
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Waterlow评分量表灵敏度为100.00%,特异度为88.23%;Braden评分量表灵敏度100.00%,特异度73.82%;两者在灵敏度和阳性值差异无统计学意义(P>0.05),Waterlow评分量表特异度和阴性预测上均高于Braden评分量表(P < 0.01)(见表 2)。
量表 灵敏度 特异度 阳性预测值 阴性预测值 Waterlow评分量表 100.00 88.23 6.08 82.87 Braden评分量表 100.00 73.82 6.08 69.34 χ2 0.00 45.94 0.00 36.47 P >0.05 < 0.01 >0.05 < 0.01 表 2 2种评分的预测效果比较(%)
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Waterlow量表曲线下面积为0.770(P < 0.05),略大于Braten量表曲线下面积的0.704(P < 0.05)(见图 1)。
Waterlow压力性损伤量表与Braden压力性量表在预测ICU病人压疮预防中的价值
Value of the Waterlow stress injury scale and Braden stress scale in predicting the prevention of pressure ulcer in ICU patients
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摘要:
目的 探究Waterlow压力性损伤量表与Braden压力性量表在预测ICU病人压疮预防中的价值。 方法 选取724例病人作为研究对象,采用Waterlow量表和Braten量表对病人压疮情况进行预测,并与最终压疮发生结果比较,观察2种量表的预测价值。 结果 Waterlow评分量表中,真阳性44例,真阴性600例;灵敏度为100.00%,特异度为88.23%。Braden评分量表真阳性为44例,真阴性为178例;灵敏度100.00%,特异度73.82%;Waterlow评分量表在特异度和阴性预测值上高于Braden评分量表(P < 0.01),但在敏感度和阳性预测值上差异无统计学意义(P>0.05)。在ROC曲线中,Waterlow量表曲线下面积为0.770(P < 0.05),略高于Braten评分量表曲线下面积的0.704(P < 0.05)。 结论 对ICU病人压疮预防过程中,Waterlow评分量表与Braden评分量表相比,特异性较好;但临床实际中,护理人员需根据量表采取针对性的护理措施。 -
关键词:
- 压疮 /
- Waterlow评分量表 /
- Braten评分量表 /
- 预防
Abstract:Objective To explore the value of the Waterlow pressure injury scale and Braden stress scale in predicting the prevention of pressure ucler in ICU. Methods The Waterlow scale and Braten scale were used to predict the pressure ulcers of 724 patients, the predictive value of two scales were compared with the final pressure ulcers, and the predictive value of two scales were analyzed. Results The true positive in 44 cases and true negative in 600 cases were identified using the Waterlow rating scale, and the sensitivity and specificity of which were 100.00% and 88.23%, respectively.The true positive in 44 cases and true negative in 178 cases were identified using the Braden rating scale, and the sensitivity and specificity of which were 100.00% and 73.82%, respectively.The specificity and negative predictive value of Waterlow rating scale were significantly higher than those of Braden rating scale(P < 0.01), and the differences of the sensitivity and positive predictive value bewteen the two scales were not statistically significant(P>0.05).The area under the Waterlow rating scale curve(0.770) was slightly higher than that of Braten rating scale curve(0.704) (P < 0.05). Conclusions During the process of pressure ulcer prevention in ICU patients, the specificity of Waterlow rating scale is better than that of Braden rating scale.In clinical practice, the nursing staff should take specific nursing measures according to the scale. -
Key words:
- pressure ulcer /
- Waterlow rating scale /
- Braten rating scale /
- prevention
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表 1 2种评分与实际压疮比较[n; 百分率(%)]
是否发生压疮 Braden评分量表 Waterlow评分量表 高风险 低风险 高风险 低风险 是 44(6.08) 0(0.00) 44(6.08) 0(0.00) 否 502(69.34) 178(24.59) 80(11.05) 600(82.87) 表 2 2种评分的预测效果比较(%)
量表 灵敏度 特异度 阳性预测值 阴性预测值 Waterlow评分量表 100.00 88.23 6.08 82.87 Braden评分量表 100.00 73.82 6.08 69.34 χ2 0.00 45.94 0.00 36.47 P >0.05 < 0.01 >0.05 < 0.01 -
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