老年急性脑卒中患者经鼻高流量氧疗后呼吸困难信念现状及相关影响因素分析OACSTPCD
Analysis of current status and related influencing factors of dyspnea beliefs in elderly patients with acute stroke after nasal high-flow oxygen therapy
目的 探讨老年急性脑卒中(CVA)患者经鼻高流量氧疗后(HFNC)呼吸困难信念现状及影响因素.方法 回顾性选取2022 年1 月—2023 年1 月首都医科大学附属北京天坛医院收治的136 例老年CVA经HFNC患者作为研究对象,采用呼吸困难信念问卷(BBQ)进行呼吸困难信念评分,得分率=分值/满分×100%,将得分率＜满分的60%设为低呼吸困难信念组,得分率≥满分的60%设为高呼吸困难信念组.比较2 组文化程度、性别、领悟社会支持量表(PSSS)、住院时间、日常生活活动能力(ADL)、24 项自我效能感量表(SEES)差异,并通过二元Logistic 回归分析高呼吸困难信念的影响因素.结果 研究共纳入136 例老年CVA经HFNC患者,其中低呼吸困难信念组87 例,高呼吸困难信念组49 例;低呼吸困难信念组年龄、肺部感染控制、昏迷、吞咽功能、咳嗽反射、SEES评分、PSSS评分、ADL、是否规律体育锻炼、HFNC设置温度、发病后救治时间评估值与高呼吸困难信念组差异均有统计学意义(P＜0.05);二元Logistic分析结果显示,年龄＞75岁(OR =1.719,P =0.004)、吞咽功能越差(OR =1.735,P =0.006)、咳嗽反射越差(OR =1.898,P =0.000 4)、SEES评分低(OR =1.785,P =0.002)、PSSS评分低(OR =1.599,P =0.006)、不规律体育锻炼(OR =1.634,P =0.003)、HFNC设置温度≥37℃(OR =1.621,P =0.006)均为影响老年CVA患者HFNC后呼吸困难信念的独立危险因素(P＜0.05);构建老年CVA患者HFNC后高呼吸困难信念的风险预测模型,以模型新生成概率值为依据,绘制预测模型ROC曲线,得到AUC =0.769 0(95%CI为0.681～0.759)＞0.75;Hosmer-Lemeshow检验评价模型校准能力(χ2 =3.543,P =0.896＞0.05).结论 老年CVA患者经HFNC后呼吸困难信念总体处于较低水平,临床工作者应早期识别患者经HFNC后呼吸困难的动机,纠正他们对呼吸困难的灾害性认识,制定针对性干预措施,促进患者心理调适和疾病康复.
Objective To explore the current status and influencing factors of dyspnea beliefs in patients with acute stroke(CVA)after nasal high-flow oxygen therapy(HFNC).Methods A total of 136 elderly CVA patients with HFNC trea-ted in Beijing Tiantan Hospital Affiliated to Capital Medical University from January 2022 to January 2023 were retrospectively selected as the study subjects.The Breathless Beliefs Questionnaire(BBQ)was used to evaluate the score of dyspnea belief.The score rate =score/full score×100%.Patients with a score rate＜60%of full score were included in the low dyspnea be-lief group,and patients with a score rate≥60%of full score were included in the high dyspnea belief group.The differences in cultural level,gender,Perceived Social Support Scale(PSSS)score,hospital stay,Activities of Daily Living Ability(ADL)and24-item Self-Efficacy Scale(SEES)scores were compared between the two groups.The influencing factors of high dyspnea belief were analyzed by binary logistic regression analysis.Results A total of 136 elderly CVA patients with HFNC were included,including 87 ones in the low dyspnea belief group and 49 ones in the high dyspnea belief group.There were significant differences in age,pulmonary infection control,coma,swallowing function,cough reflex,SEES score,PSSS score,ADL score,whether regular physical exercise,HFNC setting temperature,and treatment time after onset between the low dyspnea belief group and the high dyspnea belief group(P＜0.05).The results of binary Logistic analysis showed that age＞75 years(OR =1.719,P =0.004),worse swallowing function(OR =1.735,P =0.006),worse cough reflex(OR =1.898,P =0.000 4),lower SEES score(OR =1.785,P =0.002),lower PSSS score(OR =1.599,P =0.006),irregular physical exercise(OR =1.634,P =0.003),HFNC setting temperature≥37℃(OR =1.621,P =0.006)were all independent risk factors affecting the dyspnea belief of elderly CVA patients after HFNC(P＜0.05).A risk prediction model for high dyspnea belief in elderly CVA patients after HFNC was constructed.Based on the newly generated probability values of the model,the ROC curve of the prediction model was plotted,and its AUC was0.769 0(95%CI,0.681～0.759)＞0.75.Hosmer Leme-show test was used to evaluate the calibration ability of the model(χ2 =3.543,P =0.896＞0.05).Conclusion The overall level of dyspnea belief in CVA patients after HFNC is relatively low.Clinical workers should early identify the motivation of patients with dyspnea after HFNC,correct their catastrophic understanding of dyspnea,formulate targeted intervention meas-ures,and promote their psychological adjustment and disease recovery.
李静;赵蕊;张春花;韩丽
首都医科大学附属北京天坛医院急诊科,北京 100070
老年急性脑卒中呼吸困难信念经鼻高流量氧疗危险因素模型
elderlyacute strokedyspneabeliefnasal high flow oxygen therapyrisk factormodel
《老年医学与保健》 2024 (002)
336-342 / 7
评论