慢阻肺危重患者压力性损伤的流行病学和结局：倾向评分调整分析| Int J Nurs Stud
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慢阻肺危重患者压力性损伤的流行病学和结局：倾向评分调整分析| Int J Nurs Stud论文查重免费检测,民族区域自治制度的核心,十八洞村隶属于湖南省什么地方,
作者：NursingResearch护理研究前
Abstract
Background
Pressure injuries are a frequent complication in intensive care unit (ICU) patients, especially in those with comorbid conditions such as chronic obstructive pulmonary disease (COPD). Yet no epidemiological data on pressure injuries in critically ill COPD patients are available.
Objective
To assess the prevalence of ICU-acquired pressure injuries in critically ill COPD patients and to investigate associations between COPD status, presence of ICU-acquired pressure injury, and mortality.
Study design and methods
This is a secondary analysis of prospectively collected data from DecubICUs, a multinational one-day point-prevalence study of pressure injuries in adult ICU patients. We generated a propensity score summarizing risk for COPD and ICU-acquired pressure injury. The propensity score was used as matching criterion (1:1-ratio) to assess the proportion of ICU-acquired pressure injury attributable to COPD. The propensity score was then used in regression modelling assessing the association of COPD with risk of ICU-acquired pressure injury, and examining variables associated with mortality (Cox proportional-hazard regression).
Results
Of the 13,254 patients recruited to DecubICUs, 1663 (12.5%) had documented COPD. ICU-acquired pressure injury prevalence was higher in COPD patients: 22.1% (95% confidence interval [CI] 20.2 to 24.2) vs. 15.3% (95% CI 14.7 to 16.0). COPD was independently associated with developing ICU-acquired pressure injury (odds ratio 1.40, 95% CI 1.23 to 1.61); the proportion attributable to COPD was 6.4% (95% CI 5.2 to 7.6). Compared with non-COPD patients without pressure injury, mortality was no different among patients without COPD but with pressure injury (hazard ratio [HR] 1.07, 95% CI 0.97 to 1.17) or COPD patients without pressure injury (HR 1.13, 95% CI 1.00 to 1.27). Mortality was higher among COPD patients with pressure injury (HR 1.35, 95% CI 1.15 to 1.58).
Conclusion and Implications
Critically ill COPD patients have a statistically significant higher risk of pressure injury. Moreover, those that develop pressure injury are at higher risk of mortality. As such, pressure injury may serve as a surrogate for poor prognostic status to help clinicians identify patients at high risk of death. Also, delivery of interventions to prevent pressure injury are paramount in critically ill COPD patients. Further studies should determine if early intervention in critically ill COPD patients can modify development of pressure injury and improve prognosis.
Keywords
Pressure injuries
COPD
intensive care
comorbidity
decubitus ulcers
摘要翻译（仅供参考）
背景
压力损伤是重症监护病房 (ICU) 患者的常见并发症，尤其是在患有慢性阻塞性肺病 (COPD) 等合并症的患者中。然而，目前还没有关于重症 COPD 患者压力损伤的流行病学数据。
客观的
评估重症 COPD 患者 ICU 获得性压力损伤的患病率，并研究 COPD 状态、ICU 获得性压力损伤和死亡率之间的关联。
研究设计和方法
这是对来自DecubICUs的前瞻性收集数据的二次分析， DecubICUs是一项针对成人 ICU 患者压力损伤的多国一日点患病率研究。我们生成了一个倾向评分，总结了 COPD 和 ICU 获得性压力损伤的风险。倾向评分被用作匹配标准（1:1 比率）来评估 ICU 获得性压力损伤归因于 COPD 的比例。然后将倾向评分用于回归模型，评估 COPD 与 ICU 获得性压力损伤风险的关联，并检查与死亡率相关的变量（Cox 比例风险回归）。
结果
在招募到DecubICUs的 13,254 名患者中，1663 名 (12.5%) 记录了 COPD。COPD 患者的 ICU 获得性压力损伤发生率较高：22.1%（95% 置信区间 [CI] 20.2 至 24.2）vs . 15.3%（95% CI 14.7 至 16.0）。COPD 与发生 ICU 获得性压力性损伤独立相关（比值比 1.40，95% CI 1.23 至 1.61）；可归因于 COPD 的比例为 6.4%（95% CI 5.2 至 7.6）。与无压力损伤的非 COPD 患者相比，无 COPD 但有压力损伤的患者（风险比 [HR] 1.07，95% CI 0.97 至 1.17）或无压力损伤的 COPD 患者（HR 1.13，95% CI）的死亡率没有差异1.00 至 1.27）。患有压力性损伤的 COPD 患者的死亡率更高（HR 1.35，95% CI 1.15 至 1.58）。
结论和启示
重症慢性阻塞性肺病患者的压力性损伤风险在统计学上显着增加。此外，那些发生压力性损伤的人死亡风险更高。因此，压力性损伤可以作为预后不良的替代指标，以帮助临床医生识别具有高死亡风险的患者。此外，预防压力性损伤的干预措施对重症 COPD 患者至关重要。进一步的研究应该确定对重症 COPD 患者的早期干预是否可以改变压力性损伤的发展并改善预后。
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