| Objective:Objective to investigate the risk factors of perioperative stress injury in elderly patients with hip fracture,and to explore the application effect and optimal critical value of Braden,Waterlow and Chinese version of Munro stress injury risk assessment scales in elderly patients with hip fracture during perioperative period,so as to provide theoretical basis for clinical selection of the best stress injury risk assessment scale.Methods:In this study,convenient sampling method was used to select the elderly patients with hip fracture in the geriatric ward of two Grade-A hospitals from August to December in 2019 and October to November in 2019 as the research objects,.risk factors of stress injury were investigated and evaluated.The risk assessment and nursing of 165 patients with hip fracture before,during and after operation were assessed by Braden,Waterlow and Chinese version of Munro three kinds of stress injury risk assessment scales.SPSS17.0 and medcalc19.0 were used for data analysis.Results:1.The main risk factors of perioperative stress injury in elderly patients with hip fracture.(1)There were 27 cases of pressure injury in 180 elderly patients with hip fracture,the incidence rate was 15%.(2)The selected risk factors were analyzed by single factor analysis,among which the education level,hospitalization days,hemoglobin,serum protein,nutritional screening,operation duration,fracture type,operation mode and complications were statistically significant differences.(3)The indexes with statistical differences in univariate analysis were included in multiple linear regression analysis,it was found that the operation mode(t=-2.973,P=0.003),operation duration(t=-2.340,P=0.020),education level(t=1.988,P=0.048)and serum protein(t=-2.490,P=0.014)were the important influencing factors of perioperative stress injury in elderly patients with hip fracture.2.Three risk assessment scales for hip fracture in the elderly(1)The Kendall concordance coefficients of three risk assessment scales were 0.943,0.944 and 0.995,respectively,P<0.001.(2)When the critical values of Braden scale were 11,11 and 13 points respectively before,during and after operation,the application effect of Braden scale was the best,the sensitivity of Braden scale was 25.93%,62.96%and 51.85%,the specificity was 86.93%,75.82%,60.78%,the positive predictive value was 25.90%,31.50%,18.90%,and the negative predictive value was 86.90%,92.10%,87.70%,respectively.(3)When the critical value of Waterlow scale was 17,29 and 22 points before,during and after operation,the application effect of Waterlow scale was the best,the sensitivity was 100%,88.89%,92.59%;the specificity was64.71%,66.01%,63.40%;the positive predictive value was 33.30%,31.60%,30.90%;the negative predictive value was 100%,97.10%,98.00%.(4)When the critical values of the Chinese version of Munro scale were 8,20 and 23 points respectively,the application effect was the best,the sensitivity was 85.19%,85.19%,88.89%;the specificity was 53.59%,64.71%,60.13%;the positive predictive value was 24.50%,29.90%,28.20%;the negative predictive value was 95.30%,96.10%,96.80%.(5)The preoperative,intraoperative and postoperative Youden indexes of Braden,Waterlow and Chinese version of Munro scales were 0.1285,0.3878,0.1264;0.6471,0.5490,0.5599;0.3878,0.4989,0.4902,respectively.The area under ROC curve were 0.565,0.716,0.571;0.856,0.809,0.835;0.757,0.793,0.820,respectively.Conclusion:1.Operation mode,operation duration,education level and serum protein were the important influencing factors of stress injury in elderly patients with hip fracture during perioperative period.2.The comprehensive prediction ability of Waterlow risk assessment scale is better than that of Braden and Chinese version of Munro risk assessment scale,and it is more suitable for perioperative stress injury risk screening of elderly patients with hip fracture,which can be used preferentially. |
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