顱腦損傷并發(fā)低鈉血癥預(yù)警評分構(gòu)建及系統(tǒng)護(hù)理干預(yù)效果研究
發(fā)布時(shí)間：2018-07-14 21:38
【摘要】：目的:1.通過回顧性研究,明確顱腦損傷患者發(fā)生低鈉血癥的相關(guān)危險(xiǎn)因素,找出中等以上關(guān)聯(lián)強(qiáng)度的危險(xiǎn)因素;2.基于回顧性研究中得出的中等以上關(guān)聯(lián)強(qiáng)度的危險(xiǎn)因素,構(gòu)建顱腦損傷并發(fā)低鈉血癥預(yù)警評分表,早期明確顱腦損傷患者發(fā)生低鈉血癥的的風(fēng)險(xiǎn),篩選出高風(fēng)險(xiǎn)患者作為護(hù)士的重點(diǎn)觀察對象;3.基于顱腦損傷并發(fā)低鈉血癥預(yù)警評分表,對低風(fēng)險(xiǎn)患者和高風(fēng)險(xiǎn)患者分別采取不同的系統(tǒng)護(hù)理干預(yù)措施并評價(jià)其應(yīng)用效果,為預(yù)防顱腦損傷患者發(fā)生低鈉血癥臨床護(hù)理提供參考依據(jù)。方法:本研究分為三個(gè)階段,第一階段:收集山西省某三甲醫(yī)院2015年1月至2015年12月出院的顱腦損傷患者病歷資料,進(jìn)行回顧性分析,首先進(jìn)行單因素分析,尋找顱腦損傷患者發(fā)生低鈉血癥的相關(guān)危險(xiǎn)因素,P0.05為差異有統(tǒng)計(jì)學(xué)意義,以是否發(fā)生低鈉血癥為應(yīng)變量,有統(tǒng)計(jì)學(xué)意義的相關(guān)危險(xiǎn)因素為自變量,進(jìn)行多因素Logistic回歸分析(α入=0.05,α出=0.10),明確影響低鈉血癥發(fā)生的獨(dú)立危險(xiǎn)因素,并確定中等以上關(guān)聯(lián)強(qiáng)度的危險(xiǎn)因素;第二階段:提取第一階段研究中確定為中等以上關(guān)聯(lián)強(qiáng)度的危險(xiǎn)因素及其Logistic回歸分析結(jié)果,建立Logistic回歸模型,根據(jù)Logistic回歸模型的回歸系數(shù)對各危險(xiǎn)因素進(jìn)行賦值,建立顱腦損傷并發(fā)低鈉血癥預(yù)警評分表,并通過病例診斷試驗(yàn)與ROC分析評價(jià)該預(yù)警評分表的能效,同時(shí)進(jìn)行風(fēng)險(xiǎn)分級,運(yùn)用χ2檢驗(yàn),檢驗(yàn)分級標(biāo)準(zhǔn)的可靠性;第三階段:通過歷史對照研究方法對系統(tǒng)護(hù)理干預(yù)方案進(jìn)行臨床應(yīng)用效果評價(jià),選擇山西省某三甲醫(yī)院2016年4月至2016年10月在神經(jīng)外科住院的顱腦損傷患者為干預(yù)組,2015年1月至2015年12月出院的顱腦損傷患者為對照組,收集并比較兩組患者低鈉血癥的發(fā)生率、預(yù)后情況、平均住院時(shí)間及住院費(fèi)用等。應(yīng)用SPSS17.0軟件包進(jìn)行統(tǒng)計(jì)學(xué)分析,計(jì)量資料比較采用兩獨(dú)立樣本t檢驗(yàn),計(jì)數(shù)資料采用χ2檢驗(yàn),總體不符合正態(tài)分布的數(shù)據(jù)資料,采取秩和檢驗(yàn),p0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:(1)危險(xiǎn)因素分析結(jié)果:嚴(yán)格按照納入排除標(biāo)準(zhǔn)共收集343例顱腦損傷患者病歷資料,199例患者發(fā)生低鈉血癥,年齡≥60歲、gcs評分≤12分、急性硬膜外血腫、腦挫裂傷、腦疝、彌漫性軸索損傷、腦內(nèi)血腫、血腫清除術(shù)、鉆孔引流術(shù)、感染、高熱、禁飲食、嘔吐、使用呋塞米或甘露醇可能增加顱腦損傷患者發(fā)生低鈉血癥的風(fēng)險(xiǎn),年齡≥60歲、gcs評分≤12分、急性硬膜外血腫、腦挫裂傷、感染、高熱、使用甘露醇是顱腦損傷患者發(fā)生低鈉血癥的獨(dú)立危險(xiǎn)因素,or值范圍2.079~3.518,關(guān)聯(lián)強(qiáng)度皆在中等以上;(2)根據(jù)中等關(guān)聯(lián)強(qiáng)度以上危險(xiǎn)因素及其logistic回歸分析結(jié)果,建立logistic回歸模型p=ey/(1+ey),e=2.718,y=0.815×年齡+0.867×gcs評分+1.243×急性硬膜外血腫+0.732×腦挫裂傷+1.258×感染+0.987×高熱+1.207×使用甘露醇,在回歸模型基礎(chǔ)上建立預(yù)警評分:年齡≥60歲為0.8分,gcs評分≤12分為0.9分,急性硬膜外血腫為1.2分,腦挫裂傷為0.7分,感染為1.3分,高熱為1分,使用甘露醇為1.2分,總分為7.1分,1.8分為低風(fēng)險(xiǎn)組,≥1.8分為高風(fēng)險(xiǎn)組,該預(yù)警評分的roc曲線下面積為0.861,靈敏度和特異度分別為79.4%和80.6%,χ2檢驗(yàn)結(jié)果:χ2=109.008,p0.05,風(fēng)險(xiǎn)分級可靠;(3)嚴(yán)格按照納入排除標(biāo)準(zhǔn)共納入98例顱腦損傷患者實(shí)施系統(tǒng)護(hù)理干預(yù),干預(yù)組發(fā)生低鈉血癥43例,低鈉血癥發(fā)生率為43.88%(43/98),明顯低于對照組低鈉血癥發(fā)生率(58.02%,199/343)(p0.05);對照組患者有9例死亡,干預(yù)組患者死亡3例,兩組死亡率比較差異無統(tǒng)計(jì)學(xué)意義(p0.05);干預(yù)組平均住院天數(shù)為10.0±9.0天,對照組平均住院天數(shù)為15.0±13.0天,干預(yù)組平均住院天數(shù)少于對照組(p0.05);干預(yù)組總住院費(fèi)用為31300.18±37727.48元,日平均住院費(fèi)用為2287.36±1732.35元,對照組總住院費(fèi)用為33431.35±47920.92元,日平均住院費(fèi)用為2418.26.06±1713.20元,干預(yù)組住院費(fèi)用與對照組比較差異無統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:1.顱腦損傷患者低鈉血癥發(fā)生率較高,年齡≥60歲,GCS評分≤12分、合并急性硬膜外血腫等可能是顱腦損傷患者發(fā)生低鈉血癥的獨(dú)立危險(xiǎn)因素,護(hù)士在臨床工作應(yīng)格外重視此類患者。2.本研究中制定的顱腦損傷并發(fā)低鈉血癥預(yù)警評分表簡潔、實(shí)用,可以為臨床評估顱腦損傷患者低鈉血癥發(fā)生風(fēng)險(xiǎn)提供依據(jù)。3.系統(tǒng)護(hù)理干預(yù)方案對降低顱腦損傷患者低鈉血癥的發(fā)生率,縮短顱腦損傷患者住院時(shí)間有一定的作用。
[Abstract]:Objective: 1. through a retrospective study, the risk factors associated with hyponatremia in patients with craniocerebral injury were identified, and the risk factors for moderate or above associated intensity were identified. (2.) based on the risk factors of moderate or above associated intensity in the retrospective study, the early warning score of hyponatremia with craniocerebral injury was constructed and the patients with craniocerebral injury were identified early. The risk of hyponatremia was identified, and high-risk patients were selected as the key subjects for nurses. 3. based on the early warning score of hyponatremia with craniocerebral injury and hyponatremia, different systematic nursing interventions were taken on low risk patients and high-risk patients and their application effects were evaluated in order to prevent the incidence of hyponatremia in patients with craniocerebral injury. Bed nursing provides reference basis. Methods: This study is divided into three stages. First stage: collecting the medical records of the patients who were discharged from the hospital from January 2015 to December 2015 in Shanxi Province, and carried out a retrospective analysis. First, a single factor analysis was carried out to find the related risk factors of hyponatremia in the patients with craniocerebral injury, and the P0.05 was poor. The difference was statistically significant, with the occurrence of hyponatremia as the dependent variable, the relevant risk factors of statistical significance were independent variables, multi factor Logistic regression analysis (alpha into =0.05, alpha =0.10), the independent risk factors of hyponatremia, and the risk factors of the correlation intensity above, the second stage: extraction first In the study, the risk factors and the Logistic regression analysis were determined as the risk factors of moderate or above correlation intensity, and the Logistic regression model was established. According to the regression coefficient of the Logistic regression model, the risk factors were assigned, and the early warning score of hyponatremia with craniocerebral injury was established, and the case diagnosis test and ROC analysis were used to evaluate the precondition. The energy efficiency of the alarm score table, risk classification at the same time, the use of the chi 2 test, test the reliability of the classification standard; the third stage: through the historical control method of systematic nursing intervention in the clinical application of evaluation, selection of a three a hospital in Shanxi from April 2016 to October 2016 in the Department of neurosurgery in the brain injury patients as dry as a dry In the pre group, the patients who were discharged from January 2015 to December 2015 were the control group. The incidence of hyponatremia, the prognosis, the average time of hospitalization and the cost of hospitalization were collected and compared in the two groups. The SPSS17.0 software package was used for statistical analysis, and the measurement data were compared with two independent samples t test, and the count data were tested by chi 2 test. The data were not consistent with normal distribution, and the P0.05 was statistically significant. Results: (1) analysis of the risk factors: 343 cases of craniocerebral injury patients were collected strictly according to the inclusion criteria, 199 patients had hyponatremia, aged more than 60 years, GCS score was less than 12, acute epidural hematoma, and brain contusion Injury, hernia, diffuse axonal injury, intracerebral hematoma, hematoma, drainage, infection, high fever, diet, vomiting, furosemide or mannitol may increase the risk of hyponatremia in patients with craniocerebral injury, age 60, score of less than 12, acute epidural hematoma, brain contusion, infection, high fever, and mannitol as the cranium The independent risk factors of hyponatremia occurred in the patients with brain injury, the or range was 2.079~3.518, and the correlation intensity was above medium. (2) according to the risk factors above the moderate intensity and the results of logistic regression analysis, the logistic regression model p=ey/ (1+ey), e=2.718, y= 0.815 x age +0.867 x GCS score +1.243 x acute epidural hematoma +0.73 2 * brain contusion +1.258 * infected +0.987 * hyperthermia +1.207 * using mannitol. On the basis of the regression model, an early warning score was established: 0.8 points for age 60 years old, 0.9 points for GCS score, 1.2 points for acute epidural hematoma, 0.7 in cerebral contusion and laceration, 1.3 for infection, 1 in high fever, 1.2 in mannitol, 7.1 in mannitol, and low in 1.8 points The risk group was higher than 1.8 of the high risk group, the area under the ROC curve of the early warning score was 0.861, the sensitivity and specificity were 79.4% and 80.6% respectively. The x 2 test results: X 2=109.008, P0.05, the risk classification was reliable; (3) strictly according to the inclusion criteria included 98 cases of craniocerebral injury patients carried out systematic nursing intervention, and the intervention group had 43 cases of hyponatremia. The incidence of hyponatremia was 43.88% (43/98), which was significantly lower than the incidence of hyponatremia (58.02%, 199/343) in the control group (P0.05). There were 9 cases of death in the control group and 3 cases of death in the intervention group. The mortality rate of the two groups was not statistically significant (P0.05); the average hospitalization days in the intervention group were 10 + 9 days, and the average hospital days in the control group were 15 + 13 days. The average hospitalization days of the intervention group were less than that of the control group (P0.05), the total hospitalization expenses of the intervention group were 31300.18 + 37727.48 yuan, the average daily hospitalization cost was 2287.36 + 1732.35 yuan, the total hospitalization expenses of the control group were 33431.35 + 47920.92 yuan, and the daily average hospitalization cost was 2418.26.06 + 1713.20 yuan. The difference of hospitalization expenses in the intervention group was not statistically significant compared with the control group. Significance (P0.05). Conclusion: 1. the incidence of hyponatremia in patients with craniocerebral injury is high, age over 60 years, GCS score is less than 12 points, and acute epidural hematoma may be an independent risk factor for hyponatremia in patients with craniocerebral injury. The nurses should pay more attention to the craniocerebral injury in this kind of patient's.2. study complicated with low sodium blood. The symptom early warning score table is simple and practical. It can provide a basis for the clinical evaluation of the risk of hyponatremia in the patients with craniocerebral injury. The.3. system nursing intervention scheme can reduce the incidence of hyponatremia in the patients with craniocerebral injury and shorten the hospitalization time of the patients with craniocerebral injury.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473.6
本文編號：2123031
[Abstract]:Objective: 1. through a retrospective study, the risk factors associated with hyponatremia in patients with craniocerebral injury were identified, and the risk factors for moderate or above associated intensity were identified. (2.) based on the risk factors of moderate or above associated intensity in the retrospective study, the early warning score of hyponatremia with craniocerebral injury was constructed and the patients with craniocerebral injury were identified early. The risk of hyponatremia was identified, and high-risk patients were selected as the key subjects for nurses. 3. based on the early warning score of hyponatremia with craniocerebral injury and hyponatremia, different systematic nursing interventions were taken on low risk patients and high-risk patients and their application effects were evaluated in order to prevent the incidence of hyponatremia in patients with craniocerebral injury. Bed nursing provides reference basis. Methods: This study is divided into three stages. First stage: collecting the medical records of the patients who were discharged from the hospital from January 2015 to December 2015 in Shanxi Province, and carried out a retrospective analysis. First, a single factor analysis was carried out to find the related risk factors of hyponatremia in the patients with craniocerebral injury, and the P0.05 was poor. The difference was statistically significant, with the occurrence of hyponatremia as the dependent variable, the relevant risk factors of statistical significance were independent variables, multi factor Logistic regression analysis (alpha into =0.05, alpha =0.10), the independent risk factors of hyponatremia, and the risk factors of the correlation intensity above, the second stage: extraction first In the study, the risk factors and the Logistic regression analysis were determined as the risk factors of moderate or above correlation intensity, and the Logistic regression model was established. According to the regression coefficient of the Logistic regression model, the risk factors were assigned, and the early warning score of hyponatremia with craniocerebral injury was established, and the case diagnosis test and ROC analysis were used to evaluate the precondition. The energy efficiency of the alarm score table, risk classification at the same time, the use of the chi 2 test, test the reliability of the classification standard; the third stage: through the historical control method of systematic nursing intervention in the clinical application of evaluation, selection of a three a hospital in Shanxi from April 2016 to October 2016 in the Department of neurosurgery in the brain injury patients as dry as a dry In the pre group, the patients who were discharged from January 2015 to December 2015 were the control group. The incidence of hyponatremia, the prognosis, the average time of hospitalization and the cost of hospitalization were collected and compared in the two groups. The SPSS17.0 software package was used for statistical analysis, and the measurement data were compared with two independent samples t test, and the count data were tested by chi 2 test. The data were not consistent with normal distribution, and the P0.05 was statistically significant. Results: (1) analysis of the risk factors: 343 cases of craniocerebral injury patients were collected strictly according to the inclusion criteria, 199 patients had hyponatremia, aged more than 60 years, GCS score was less than 12, acute epidural hematoma, and brain contusion Injury, hernia, diffuse axonal injury, intracerebral hematoma, hematoma, drainage, infection, high fever, diet, vomiting, furosemide or mannitol may increase the risk of hyponatremia in patients with craniocerebral injury, age 60, score of less than 12, acute epidural hematoma, brain contusion, infection, high fever, and mannitol as the cranium The independent risk factors of hyponatremia occurred in the patients with brain injury, the or range was 2.079~3.518, and the correlation intensity was above medium. (2) according to the risk factors above the moderate intensity and the results of logistic regression analysis, the logistic regression model p=ey/ (1+ey), e=2.718, y= 0.815 x age +0.867 x GCS score +1.243 x acute epidural hematoma +0.73 2 * brain contusion +1.258 * infected +0.987 * hyperthermia +1.207 * using mannitol. On the basis of the regression model, an early warning score was established: 0.8 points for age 60 years old, 0.9 points for GCS score, 1.2 points for acute epidural hematoma, 0.7 in cerebral contusion and laceration, 1.3 for infection, 1 in high fever, 1.2 in mannitol, 7.1 in mannitol, and low in 1.8 points The risk group was higher than 1.8 of the high risk group, the area under the ROC curve of the early warning score was 0.861, the sensitivity and specificity were 79.4% and 80.6% respectively. The x 2 test results: X 2=109.008, P0.05, the risk classification was reliable; (3) strictly according to the inclusion criteria included 98 cases of craniocerebral injury patients carried out systematic nursing intervention, and the intervention group had 43 cases of hyponatremia. The incidence of hyponatremia was 43.88% (43/98), which was significantly lower than the incidence of hyponatremia (58.02%, 199/343) in the control group (P0.05). There were 9 cases of death in the control group and 3 cases of death in the intervention group. The mortality rate of the two groups was not statistically significant (P0.05); the average hospitalization days in the intervention group were 10 + 9 days, and the average hospital days in the control group were 15 + 13 days. The average hospitalization days of the intervention group were less than that of the control group (P0.05), the total hospitalization expenses of the intervention group were 31300.18 + 37727.48 yuan, the average daily hospitalization cost was 2287.36 + 1732.35 yuan, the total hospitalization expenses of the control group were 33431.35 + 47920.92 yuan, and the daily average hospitalization cost was 2418.26.06 + 1713.20 yuan. The difference of hospitalization expenses in the intervention group was not statistically significant compared with the control group. Significance (P0.05). Conclusion: 1. the incidence of hyponatremia in patients with craniocerebral injury is high, age over 60 years, GCS score is less than 12 points, and acute epidural hematoma may be an independent risk factor for hyponatremia in patients with craniocerebral injury. The nurses should pay more attention to the craniocerebral injury in this kind of patient's.2. study complicated with low sodium blood. The symptom early warning score table is simple and practical. It can provide a basis for the clinical evaluation of the risk of hyponatremia in the patients with craniocerebral injury. The.3. system nursing intervention scheme can reduce the incidence of hyponatremia in the patients with craniocerebral injury and shorten the hospitalization time of the patients with craniocerebral injury.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473.6
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