创伤后脓毒症护理预警评估系统软件的研发

发布时间：2018-06-03 08:41

  本文选题：创伤 + 脓毒症　； 参考：《第三军医大学》2017年硕士论文

【摘要】：研究目的1.从感染角度分析创伤患者并发脓毒症的危险因素。2.确立基于危险因素的创伤后脓毒症集束化预防护理措施。3.研发创伤后脓毒症护理预警评估系统软件。资料与方法1.收集2012-2015年227例重庆市大坪医院ICU创伤后感染患者资料,采用SPSS及Excel软件,通过T检验、×2检验、Logistic回归分析、ROC曲线分析等,得出创伤后脓毒症危险因素,据Logistic分析结果构建创伤后脓毒症预警公式,据ROC分析结果构建创伤后脓毒症风险评估量表。2.收集2012-2016年475例重庆市大坪医院创伤患者资料,通过描述性统计、预测价值分析等对创伤后脓毒症风险评估表用于创伤后脓毒症预警的有效性进行验证,包括灵敏度、特异度、阳性预测值、阴性预测值等。3.采用文献阅读法、小组讨论法、临床实践法初步拟定创伤后脓毒症集束化护理预防措施条目,经专家咨询使其最终确定。4.采用Python软件编辑工具,对创伤后脓毒症风险评估表及创伤后脓毒症集束化护理预防措施的具体内容进行信息化编程,从而构建创伤后脓毒症护理预警评估系统软件。研究结果1.明确创伤后脓毒症危险因素,包括7个,即:入院SOFA评分、入院时功能障碍系统个数、入科24 h内血p H值、入科24h脉压差平均值、葡萄球菌属感染、创面感染、有创机械通气持续时间。预警公式为:创伤后脓毒症风险评分=入院SOFA评分+0.5×入院功能障碍系统个数+入科24小时内血PH+0.5×入科24小时内脉压差平均值+1.5×葡萄球菌属感染+1.5×创面感染+0.5×有创机械通气持续时间。由ROC曲线分析得,创伤后脓毒症风险评分≥5.8即为高危患者。2.两轮专家咨询最终确立了基于创伤后脓毒症危险因素的集束化预防护理措施包括:创伤后脓毒症护理预警评估;密切监测生命体征、PH等;细菌培养中的护理;创面感染护理;机械通气相关感染的预防护理。3.研发了创伤后脓毒症护理预警评估软件,采用475例患者资料对其用于创伤患者脓毒症预测的有效性进行验证,结果显示,灵敏度为75.48%、特异度为81.65%、阳性预测值为76.21%、阴性预测值为81.04%、漏预测率为10.74%(51/475)、错预测率为10.32%(49/475)。结论创伤后脓毒症的发生,创伤是诱因,感染是前提。本课题从感染角度出发分析创伤后脓毒症的危险因素,并经专家咨询确立基于危险因素的集束化预防护理措施,最终研发了创伤后脓毒症护理预警评估系统软件,本软件方便简洁、对创伤后脓毒症具有良好预测效果、且适宜护理人员使用,值得在临床推广。
[Abstract]:Objective 1. From the point of view of infection, the risk factors of sepsis in trauma patients were analyzed. 2. 2. Establish risk factors based on post-traumatic sepsis cluster preventive nursing measures. 3. Research and development of post-traumatic sepsis nursing early warning evaluation system software. Data and methods 1. The data of 227 patients with post-traumatic infection of ICU in Daping Hospital of Chongqing from 2012 to 2015 were collected. The risk factors of post-traumatic sepsis were obtained by SPSS and Excel software. The risk factors of post-traumatic sepsis were analyzed by T test and Logistic regression analysis. According to the results of Logistic analysis, the formula of post-traumatic sepsis warning was constructed, and the posttraumatic sepsis risk assessment scale. 2. 2 was constructed according to the results of ROC analysis. The data of 475 trauma patients in Daping Hospital of Chongqing from 2012 to 2016 were collected. The effectiveness of post-traumatic sepsis risk assessment table was verified by descriptive statistics and predictive value analysis, including sensitivity and specificity. Positive predictive value, negative predictive value, etc. The methods of literature reading, group discussion and clinical practice were used to draw up the items of cluster nursing measures for post-traumatic sepsis. The risk assessment table of post-traumatic sepsis and the specific contents of the post-traumatic sepsis cluster nursing prevention measures were programmed with Python software editing tool, and the pre-warning evaluation system software of post-traumatic sepsis nursing was constructed. Results 1. Seven risk factors of posttraumatic sepsis were identified, including admission SOFA score, the number of dysfunction system at admission, the blood pH value within 24 hours, the mean 24 h pulse pressure difference, the infection of staphylococcus and the infection of wound. Duration of invasive mechanical ventilation. The warning formula is as follows: posttraumatic sepsis risk score = admission SOFA score 0. 5 脳 number of admission dysfunction system within 24 hours blood PH 0. 5 脳 mean pulse pressure difference within 24 hours, mean 1.5 脳 Staphylococcus infection 1. 5 脳 wound sensation 0.5 脳 duration of invasive mechanical ventilation. According to the analysis of ROC curve, the risk score of posttraumatic sepsis 鈮，

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