两种不同量表对手术获得性压力性损伤预测效果的对比研究

A comparative study on the predictive effect of two different scales on intraoperatively acquired pressure injuries

摘要:

目的： 比较改良版Munro围术期成人压疮风险评估量表与斯卡特触发点对手术患者发生压力性损伤的预测效度及评估的一致性。方法： 采用病例对照研究方法，选取2017年至2019年在重庆医科大学附属第二医院进行手术的患者270名，收集一般资料和手术资料，将确诊已发生手术获得性压力性损伤的45名患者作为病例组，根据手术科室采用1∶5配对方法，选取同期进行手术但未发生手术获得性压力性损伤的225名患者作为对照组，使用改良版Munro量表与斯卡特触发点分别评分并记录，计算受试者工作特征（receiver operating characteristic，ROC）曲线下面积（area under the curve，AUC），以及量表的约登指数、灵敏度、特异度、阳性预测值、阴性预测值、κ值结果： 病例组和对照组Munro量表评分分别为（29.870±3.279）分、（26.460±3.381）分，斯卡特触发点评分分别为（2.361±0.900）分、（1.650±0.989）分。Munro量表的AUC=0.764（95%CI=0.692～0.873），最佳诊断界值、灵敏度、特异度、阳性预测值、阴性预测值分别为28.500、0.667、0.720、0.248、0.934；斯卡特触发点AUC=0.691（95%CI=0.610～0.772），最佳诊断界值、灵敏度、特异度、阳性预测值、阴性预测值分别为1.500、0.822、0.502、0.289、0.923。两种评估量表的κ值为0.497，差异有统计学意义（P<0.05）。结论： 改良版Munro量表与斯卡特触发点均能有效评估患者发生手术获得性压力性损伤的风险，存在中度一致性。从临床实际工作出发，术前采用改良版斯卡特触发点对手术患者压力性损伤风险进行评估具有可操作性，值得推广。

Abstract:

Objective: To compare the predictive validity and the consistency of the modified Munro pressure ulcer risk assessment scale（Munro scale） and Scott triggers（ST） for adult perioperative surgical patients. Methods: A case-control study was conducted involving 270 patients who underwent surgery in The Second Affiliated Hospital of Chongqing Medical University from 2017 to 2019. Their general data and surgical data were collected. A total of 45 patients diagnosed with intraoperatively acquired pressure injuries were taken as the case group，and according to the same operation period，225 patients without intraoperatively acquired pressure injuries were selected as the control group by the 1∶5 paring method. We used the modified Munro scale and ST to score and record respectively，and the area under the curve（AUC） was calculated，as well as the Jordan index，sensitivity，specificity，positive predictive value（PPV），negative predictive value（NPV） and κ value of the scale. Results: The Munro scale scores of the case group and the control group were （29.870±3.279） points and （26.460±3.381） points，respectively，and the ST scores were （2.361±0.900） points and （1.650±0.989） points，respectively. The AUC of the Munro scale was 0.764（95%CI=0.692-0.873），and the best diagnostic limit，sensitivity，specificity，PPV，NPV were 28.500，0.667，0.720，0.248，0.934，respectively. And the AUC of ST was 0.691（95%CI=0.610-0.772），and the best diagnostic limit，sensitivity，specificity，PPV，NPV were 1.500，0.822，0.502，0.289，0.923，respectively. The κ value of the two scales was 0.497，with significant difference（P<0.05）. Conclusion: Both of the modified Munro scale and the ST can effectively evaluate the risk of intraoperatively acquired pressure injuries in surgical patients，with a moderate consistency. In the clinical practice，it’s feasible to use the modified Munro scale and the ST to evaluate the risk of intraoperatively acquired pressure injuries in surgical patients before operation，which is worth popularizing.