颅脑损伤并发低钠血症预警评分构建及系统护理干预效果研究
发布时间：2018-07-14 21:38
【摘要】：目的:1.通过回顾性研究,明确颅脑损伤患者发生低钠血症的相关危险因素,找出中等以上关联强度的危险因素;2.基于回顾性研究中得出的中等以上关联强度的危险因素,构建颅脑损伤并发低钠血症预警评分表,早期明确颅脑损伤患者发生低钠血症的的风险,筛选出高风险患者作为护士的重点观察对象;3.基于颅脑损伤并发低钠血症预警评分表,对低风险患者和高风险患者分别采取不同的系统护理干预措施并评价其应用效果,为预防颅脑损伤患者发生低钠血症临床护理提供参考依据。方法:本研究分为三个阶段,第一阶段:收集山西省某三甲医院2015年1月至2015年12月出院的颅脑损伤患者病历资料,进行回顾性分析,首先进行单因素分析,寻找颅脑损伤患者发生低钠血症的相关危险因素,P0.05为差异有统计学意义,以是否发生低钠血症为应变量,有统计学意义的相关危险因素为自变量,进行多因素Logistic回归分析(α入=0.05,α出=0.10),明确影响低钠血症发生的独立危险因素,并确定中等以上关联强度的危险因素;第二阶段:提取第一阶段研究中确定为中等以上关联强度的危险因素及其Logistic回归分析结果,建立Logistic回归模型,根据Logistic回归模型的回归系数对各危险因素进行赋值,建立颅脑损伤并发低钠血症预警评分表,并通过病例诊断试验与ROC分析评价该预警评分表的能效,同时进行风险分级,运用χ2检验,检验分级标准的可靠性;第三阶段:通过历史对照研究方法对系统护理干预方案进行临床应用效果评价,选择山西省某三甲医院2016年4月至2016年10月在神经外科住院的颅脑损伤患者为干预组,2015年1月至2015年12月出院的颅脑损伤患者为对照组,收集并比较两组患者低钠血症的发生率、预后情况、平均住院时间及住院费用等。应用SPSS17.0软件包进行统计学分析,计量资料比较采用两独立样本t检验,计数资料采用χ2检验,总体不符合正态分布的数据资料,采取秩和检验,p0.05为差异有统计学意义。结果:(1)危险因素分析结果:严格按照纳入排除标准共收集343例颅脑损伤患者病历资料,199例患者发生低钠血症,年龄≥60岁、gcs评分≤12分、急性硬膜外血肿、脑挫裂伤、脑疝、弥漫性轴索损伤、脑内血肿、血肿清除术、钻孔引流术、感染、高热、禁饮食、呕吐、使用呋塞米或甘露醇可能增加颅脑损伤患者发生低钠血症的风险,年龄≥60岁、gcs评分≤12分、急性硬膜外血肿、脑挫裂伤、感染、高热、使用甘露醇是颅脑损伤患者发生低钠血症的独立危险因素,or值范围2.079~3.518,关联强度皆在中等以上;(2)根据中等关联强度以上危险因素及其logistic回归分析结果,建立logistic回归模型p=ey/(1+ey),e=2.718,y=0.815×年龄+0.867×gcs评分+1.243×急性硬膜外血肿+0.732×脑挫裂伤+1.258×感染+0.987×高热+1.207×使用甘露醇,在回归模型基础上建立预警评分:年龄≥60岁为0.8分,gcs评分≤12分为0.9分,急性硬膜外血肿为1.2分,脑挫裂伤为0.7分,感染为1.3分,高热为1分,使用甘露醇为1.2分,总分为7.1分,1.8分为低风险组,≥1.8分为高风险组,该预警评分的roc曲线下面积为0.861,灵敏度和特异度分别为79.4%和80.6%,χ2检验结果:χ2=109.008,p0.05,风险分级可靠;(3)严格按照纳入排除标准共纳入98例颅脑损伤患者实施系统护理干预,干预组发生低钠血症43例,低钠血症发生率为43.88%(43/98),明显低于对照组低钠血症发生率(58.02%,199/343)(p0.05);对照组患者有9例死亡,干预组患者死亡3例,两组死亡率比较差异无统计学意义(p0.05);干预组平均住院天数为10.0±9.0天,对照组平均住院天数为15.0±13.0天,干预组平均住院天数少于对照组(p0.05);干预组总住院费用为31300.18±37727.48元,日平均住院费用为2287.36±1732.35元,对照组总住院费用为33431.35±47920.92元,日平均住院费用为2418.26.06±1713.20元,干预组住院费用与对照组比较差异无统计学意义(p0.05)。结论:1.颅脑损伤患者低钠血症发生率较高,年龄≥60岁,GCS评分≤12分、合并急性硬膜外血肿等可能是颅脑损伤患者发生低钠血症的独立危险因素,护士在临床工作应格外重视此类患者。2.本研究中制定的颅脑损伤并发低钠血症预警评分表简洁、实用,可以为临床评估颅脑损伤患者低钠血症发生风险提供依据。3.系统护理干预方案对降低颅脑损伤患者低钠血症的发生率,缩短颅脑损伤患者住院时间有一定的作用。
[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.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.6
本文编号：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.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.6
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