体外循环术后患者呼吸装置相关压力性损伤发生特征及影响因素

doi:10.3969/j.issn.1004-583X.2025.03.007

摘要/Abstract

摘要：

目的探讨体外循环术后患者由呼吸装置造成的器械相关压力性损伤(medical device-related pressure injury, MDRPI)的发生特征,并分析其影响因素。方法采用便利抽样法选取2023年6月-2024年4月新疆医科大学第一附属医院心脏外科重症监护室体外循环术后患者426例。依据是否发生由呼吸装置导致的MDRPI分为 MDRPI 组(n=99)和非MDRPI组(n=327)。应用单因素分析及Lasso回归筛选影响因素并纳入logistic回归分析。结果 426例患者中MDRPI 99例(22.2%)。Logistic 回归分析显示:术中肝素钠用量较多、急诊手术、术后发热、体外循环时间较长均为独立危险因素(均OR>1,P<0.05),护士能级较高、血小板水平较高均为保护因素(OR<1,P<0.05)。所构建模型AUC=0.874(95%CI:0.837~0.910),敏感度0.828,特异度0.768,模型区分度较好;H-L检验(χ²=3.094,P=0.928)模型拟合度较好。结论体外循环术后患者可因术中肝素钠用量较多、血小板水平较低、急诊手术、术后发热、体外循环时间较长及护士能级较低导致患者易并发MDRPI,临床护士应全面评估,给予预见性预防措施,从而降低其发生风险。

关键词: 体外循环, 呼吸装置, 器械相关压力性损伤, 发生特征, 影响因素分析

Abstract:

Objective To investigate the characteristics of medical device-related pressure injury (MDRPI) in patients underwent cardiopulmonary bypass, and to analyse its influencing factors. Methods A convenience sampling of 426 patients underwent cardiopulmonary bypass in the Cardiac Surgery Intensive Care Unit of the First Affiliated Hospital of Xinjiang Medical University from June 2023 to April 2024 was conducted. The patients were divided into MDRPI group (n=99) and non-MDRPI group (n=327) based on the presence or absence of MDRPI. Univariate analysis and Lasso regression were used to screen the influencing factors and included in logistic regression analysis. Results MDRPI occurred in 99 (22.2%) cases among the 426 subjects. Logistic regression analysis showed that high intraoperative heparin sodium dosage, emergency surgery, postoperative fever, and long cardiopulmonary bypass time were independent risk factors (all OR>1, P<0.05), and higher nurse level and higher platelet level were protective factors (OR<1, P<0.05). The area under the receiver operating characteristic (ROC) curve (AUC) of model was 0.874 (95%CI: 0.837-0.910), with a sensitivity of 0.828 and a specificity of 0.768. The model discrimination was good, and the Hosmer-Lemeshow (H-L) test (χ²=3.094, P=0.928) had a good fit of the model. Conclusion After cardiopulmonary bypass, patients are prone to MDRPI due to high intraoperative heparin sodium dosage, low platelet level, emergency surgery, postoperative fever, long cardiopulmonary bypass time and low nurse energy level. Clinicians should comprehensively evaluate and give predictive preventive measures to reduce the risk of MDRPI.

Key words: extracorporeal circulation, breathing apparatus, device-related pressure injury, characteristics of occurrence, root cause analysis

中图分类号:

R654.1

马琴, 王志伟, 马晶, 张莉. 体外循环术后患者呼吸装置相关压力性损伤发生特征及影响因素[J]. 临床荟萃, 2025, 40(3): 231-236.

Ma Qin, Wang Zhiwei, Ma Jing, Zhang Li. Characteristics and influencing factors of respiratory device-related pressure injury in patients underwent cardiopulmonary bypass[J]. Clinical Focus, 2025, 40(3): 231-236.

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https://lchc.magtechjournal.com/CN/Y2025/V40/I3/231

图/表 5

参考文献 23

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项目	MDRPI组(n=99)	非MDRPI组(n=327)	t/Z/χ²值	P值
性别[例(%)]
男女	54(54.55) 45(45.45)	185(56.57) 142(43.43)	0.127	0.721
BMI(kg/m²)	22.18±3.43	22.70±3.63	-1.258	0.209
年龄(岁)	58.52±10.52	54.99±11.08	2.803	0.005
诊断[例(%)]
夹层类	15(15.16)	52(15.90)
瓣膜类	27(27.27)	73(22.32)
冠状动脉搭桥	19(19.19)	46(14.07)	3.757	0.440
先天性心脏病	16(16.16)	72(22.02)
大血管手术	22(22.22)	84(25.69)
意识障碍[例(%)]
是否	35(35.35) 64(64.65)	118(36.09) 209(63.91)	0.018	0.894
水肿[例(%)]
是否	19(19.19) 80(80.81)	47(14.37) 280(85.63)	1.348	0.246
急诊手术[例(%)]
是否	26(26.26) 73(73.74)	26(7.95) 301(92.05)	22.778	<0.001
气管导管[例(%)]
是否	41(41.41) 58(58.59)	99(30.28) 228(69.72)	4.274	0.039
气管切开[例(%)]
是否	30(30.30) 69(69.70)	105(32.11) 222(67.89)	0.115	0.735
无创通气面罩[例(%)]
是否	28(28.28) 71(71.72)	98(29.97) 229(70.03)	0.104	0.747
鼻胃管[例(%)]
是否	93(93.94) 6(6.06)	289(88.38) 38(11.62)	2.537	0.111
术后发热[例(%)]
是否	47(47.47) 52(52.53)	81(24.77) 246(75.23)	18.637	<0.001
手术时长(min)	248.10(216.00,268.00)	248.75(225.00,265.00)	-0.117	0.907
术中出血量(ml)	507.86(470.00,550.00)	491.93(450.00,540.00)	-2.917	0.004
术中输血量(ml)	334.95(300.00,400.00)	330.67(300.00,400.00)	-0.457	0.648
术中肝素钠用量(mg)	219.49(180.00,258.00)	173.62(145.00,182.00)	-7.852	<0.001
体外循环时长(min)	86.97(67.00,89.00)	65.17(45.00,69.00)	-8.233	<0.001
住院时长(d)	9.33(8.00,11.00)	8.75(8.00,10.00)	-3.075	0.002
高血压史[例(%)]
是否	33(33.33) 66(66.67)	81(24.77) 246(75.23)	2.843	0.092
糖尿病史[例(%)]
是否	21(21.21) 78(78.79)	60(18.35) 267(81.65)	0.405	0.525
血清白蛋白(g/L)	34.42(32.82,35.92)	35.18(33.11,37.83)	-3.533	<0.001
血红蛋白(g/L)	121.44(109.00,132.00)	123.98(110.00,134.00)	-1.931	0.054
血小板(×10⁹/L)	155.00(150.00,182.00)	207.41(157.00,240.00)	-7.051	<0.001
镇静[例(%)]
是否	24(24.24) 75(75.76)	53(16.21) 274(83.79)	3.313	0.069
镇痛[例(%)]
是否	22(22.22) 77(77.78)	59(18.04) 268(81.96)	0.862	0.353
护士能级[例(%)]
N0	31(31.31)	46(14.07)
N1	51(51.52)	149(45.57)	24.853	<0.001
N2	13(13.13)	95(29.05)
N3	4(4.04)	37(11.31)

项目	MDRPI组(n=99)	非MDRPI组(n=327)	t/Z/χ²值	P值
性别[例(%)]
男女	54(54.55) 45(45.45)	185(56.57) 142(43.43)	0.127	0.721
BMI(kg/m²)	22.18±3.43	22.70±3.63	-1.258	0.209
年龄(岁)	58.52±10.52	54.99±11.08	2.803	0.005
诊断[例(%)]
夹层类	15(15.16)	52(15.90)
瓣膜类	27(27.27)	73(22.32)
冠状动脉搭桥	19(19.19)	46(14.07)	3.757	0.440
先天性心脏病	16(16.16)	72(22.02)
大血管手术	22(22.22)	84(25.69)
意识障碍[例(%)]
是否	35(35.35) 64(64.65)	118(36.09) 209(63.91)	0.018	0.894
水肿[例(%)]
是否	19(19.19) 80(80.81)	47(14.37) 280(85.63)	1.348	0.246
急诊手术[例(%)]
是否	26(26.26) 73(73.74)	26(7.95) 301(92.05)	22.778	<0.001
气管导管[例(%)]
是否	41(41.41) 58(58.59)	99(30.28) 228(69.72)	4.274	0.039
气管切开[例(%)]
是否	30(30.30) 69(69.70)	105(32.11) 222(67.89)	0.115	0.735
无创通气面罩[例(%)]
是否	28(28.28) 71(71.72)	98(29.97) 229(70.03)	0.104	0.747
鼻胃管[例(%)]
是否	93(93.94) 6(6.06)	289(88.38) 38(11.62)	2.537	0.111
术后发热[例(%)]
是否	47(47.47) 52(52.53)	81(24.77) 246(75.23)	18.637	<0.001
手术时长(min)	248.10(216.00,268.00)	248.75(225.00,265.00)	-0.117	0.907
术中出血量(ml)	507.86(470.00,550.00)	491.93(450.00,540.00)	-2.917	0.004
术中输血量(ml)	334.95(300.00,400.00)	330.67(300.00,400.00)	-0.457	0.648
术中肝素钠用量(mg)	219.49(180.00,258.00)	173.62(145.00,182.00)	-7.852	<0.001
体外循环时长(min)	86.97(67.00,89.00)	65.17(45.00,69.00)	-8.233	<0.001
住院时长(d)	9.33(8.00,11.00)	8.75(8.00,10.00)	-3.075	0.002
高血压史[例(%)]
是否	33(33.33) 66(66.67)	81(24.77) 246(75.23)	2.843	0.092
糖尿病史[例(%)]
是否	21(21.21) 78(78.79)	60(18.35) 267(81.65)	0.405	0.525
血清白蛋白(g/L)	34.42(32.82,35.92)	35.18(33.11,37.83)	-3.533	<0.001
血红蛋白(g/L)	121.44(109.00,132.00)	123.98(110.00,134.00)	-1.931	0.054
血小板(×10⁹/L)	155.00(150.00,182.00)	207.41(157.00,240.00)	-7.051	<0.001
镇静[例(%)]
是否	24(24.24) 75(75.76)	53(16.21) 274(83.79)	3.313	0.069
镇痛[例(%)]
是否	22(22.22) 77(77.78)	59(18.04) 268(81.96)	0.862	0.353
护士能级[例(%)]
N0	31(31.31)	46(14.07)
N1	51(51.52)	149(45.57)	24.853	<0.001
N2	13(13.13)	95(29.05)
N3	4(4.04)	37(11.31)

变量	容差	方差膨胀因子
肝素钠	0.912	1.097
血小板	0.972	1.028
急诊手术	0.971	1.029
术后发热	0.947	1.056
体外循环时长	0.973	1.028
护士能级	0.984	1.016

变量	容差	方差膨胀因子
肝素钠	0.912	1.097
血小板	0.972	1.028
急诊手术	0.971	1.029
术后发热	0.947	1.056
体外循环时长	0.973	1.028
护士能级	0.984	1.016

因素	B	SE	Wald χ²值	P值	OR值	95%CI
肝素钠	0.011	0.003	18.193	<0.001	1.011	1.006~1.016
血小板	-0.015	0.003	28.040	<0.001	0.985	0.979~0.990
急诊手术	1.331	0.373	12.746	<0.001	3.785	1.823~7.861
术后发热	0.904	0.303	8.933	0.003	2.470	1.365~4.469
体外循环时长	0.014	0.004	15.094	<0.001	1.015	1.007~1.022
护士能级			19.959	<0.001
	-1.010	0.349	8.373	0.004	0.364	0.184~0.722
	-1.740	0.463	14.131	<0.001	0.176	0.071~0.435
	-2.302	0.700	10.810	0.001	0.100	0.025~0.395
常量	-1.209	0.792	2.326	0.127	0.299