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重症监护病房患者压疮发生的危险因素
及 SOFA 评分联合 Braden 量表评分对压疮的预测价值
吴燕丽,蓝翠珍
海南医学院第二附属医院急诊科,海南 海口 570311
【摘要】 目的 探讨重症监护病房(ICU)患者压疮发生的危险因素及序贯器官功能衰竭估计(SOFA)评分联合
Braden 量表评分对压疮(PU)发生的预测价值。方法 回顾性分析 2016 年 1 月至 2019 年 2 月在海南医学院第二附
属医院 ICU 住院的 198 例患者的临床资料,根据是否发生 PU 分为 PU 组(48 例)及无 PU 组(150 例),比较两组患者的
基线资料,采用单因素分析发生 PU 的可能原因,经多因素 Logistic 回归分析发生PU的相关危险因素。应用受试者
工作特征曲线(ROC)评估SOFA 评分、Braden 量表评分及两者联合对PU 发生的预测价值。结果 ICU 住院患者 PU
发生率为 24.3%,最常见的PU 分期是Ⅰ期,最常见的 PU 发生部位是骶尾部;PU 组患者的 SOFA 评分为(7.8±2.9)分,
明显高于无 PU 组的(4.9±2.2)分,而 Braden 量表评分为(9.7±2.4)分,明显低于无 PU 组的(13.5±2.3)分,差异均有统计
学意义(P<0.05);多因素 Logistic 回归分析结果显示,年龄、SOFA 评分、ICU 住院时间、Braden量表评分、低白蛋白水
平、血管活性药物、机械通气、连续性肾脏替代治疗(CRRT)及镇静均为 ICU 患者 PU 发生的独立危险因素(P<0.05);
SOFA评分和Braden量表评分单独预测PU 发生的ROC 曲线下面积(AUC)分别为0.783 (95%CI 0.676~0.889)和0.791
(95%CI 0.687~0.894),而SOFA评分联合Braden量表评分预测PU发生的AUC为0.856 (95%CI 0.766~0.946),SOFA 评
分联合 Braden 量表评分预测PU 发生的 AUC 明显大于两种指标单独应用(Z=2.159,P=0.025)。结论 ICU 患者 PU
发生是多因素共同参与的病理生理过程,SOFA 评分联合 Braden 量表评分能更好地预测 ICU 患者 PU 发生情况,值
得临床推广应用。
【关键词】 序贯器官功能衰竭估计评分;Braden量表评分;重症监护病房;压疮;预测价值
【中图分类号】 R63 【文献标识码】 A 【文章编号】 1003—6350(2019)16—2102—05
Risk factors for pressure ulcers occurrence in intensive care unit patients and predictive value of SOFA score
combined with Braden scale score on pressure ulcers. WU Yan-li, LAN Cui-zhen. Department of Emergency, the
Second Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan, CHINA
【Abstract】 Objective To explore the risk factors for pressure ulcers in intensive care unit (ICU) patients and
the predictive value of sequential organ failure assessment (SOFA) score combined with Braden scale score on pressure
ulcer (PU). Methods A retrospective analysis was performed on the clinical data of 198 patients who were admitted to
the ICU of the Second Affiliated Hospital of Hainan Medical University from January 2016 to February 2019. According
to the presence or absence of PU, they were divided into PU group (n=48) and non-PU group (n=150). Baseline data
were compared between the two groups. The possible causes of PU were analyzed by univariate analysis. The risk fac-
tors associated with PU were analyzed by multivariate logistic regression. The receiver operating characteristic (ROC)
curve was used to evaluate the predictive value of SOFA score, Braden scale score and the combination of the two on PU
occurrence. Results The incidence of PU in ICU hospitalized patients was 24.3% . The most common PU stage was
stageⅠ. The most frequent site of PU was the appendix. The SOFA score of the PU group was 7.8±2.9, which was signif-
icantly higher than 4.9±2.2 of the non-PU group; while the Braden scale score was 9.7±2.4, which was significantly low-
er than 13.5±2.3 of the non-PU group (both P<0.05). Multivariate logistic regression analysis showed that age, SOFA
score, ICU stay, Braden scale score, low albumin levels, vasoactive drugs, mechanical ventilation, continuous renal re-
placement therapy (CRRT) and sedation were all independent risk factors for ICU patients (all P<0.05). The area under
the ROC curve (AUC) for predicting PU occurrence by SOFA score and Braden scale score was respectively 0.783 (95%
CI for the ratio, 0.676 to 0.889) and 0.791 (95% CI for the ratio, 0.687 to 0.894); while the AUC for predicting PU occur-
rence by SOFA score combined with Braden scale score was 0.856 (95% CI for the ratio, 0.766 to 0.946). The AUC for
predicting PU occurrence by SOFA score combined with Braden scale score was significantly greater than that by the
two indicators alone (Z=2.159, P=0.025). Conclusion PU occurrence in ICU patients is a pathophysiological process
involving multiple factors. SOFA score combined with Braden scale score can better predict the occurrence of PU in ICU
patients, which is worthy of clinical application.
【Key words】 Sequential organ failure estimation score; Braden scale score; Intensive care unit; Pressure ulcer;
Predictive value
·论著·
doi:10.3969/j.issn.1003-6350.2019.16.019
通讯作者:吴燕丽,E-mail:517772451@qq.com
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