摘要
Abstract
Objective To analyze the effect of hierarchical nursing intervention based on the Cox proportional hazards regression model on postoperative rebleeding in patients with hypertensive intracerebral hemorrhage(HICH).Methods A total of 136 HICH patients admitted to Kunshan Traditional Chinese Medicine Hospital from January 2021 to June 2023 were selected as the modeling cohort.Independent risk factors for postoperative rebleeding were identified using univariate and multivariate Cox proportional hazards regression models.An individualized risk scoring system was constructed for risk stratification.Subsequently,82 HICH surgical patients admitted between July 2023 and November 2024 were enrolled as the validation cohort and randomly assigned(using a random number table)to either a control group(n=41,receiving conventional nursing)or an observation group(n=41,receiving hierarchical nursing based on the Cox proportional hazards regression model).Blood pressure control immediately postoperative and within 12 hours postoperatively,rebleeding rate within 7 days postoperatively,neurological function(National Institutes of Health Stroke Scale(NIHSS)score)and incidence of complications during the intervention were compared between the two groups.Results Cox regression analysis identified age,hematoma volume,presence of underlying diseases,and postoperative blood pressure as independent risk factors for postoperative rebleeding(P<0.05).No significant difference in immediate postoperative blood pressure was found between groups(P>0.05).The peak blood pressure and fluctuation amplitude within 12 hours postoperatively were significantly lower in the observation group compared to the control group(P<0.05).The rebleeding rate within 7 days postoperatively was significantly lower in the observation group(2.44%)than in the control group(17.07%)(P<0.05).NIHSS scores decreased significantly in both groups 2 weeks after intervention,with lower scores in the observation group(P<0.05).The complication incidence was significantly lower in the observation group(4.88%)than in the control group(19.52%)(P<0.05).Conclusions The hierarchical nursing intervention system,constructed based on the Cox proportional hazards model,utilizes dynamic risk stratification integrating four independent risk factors(age,hematoma volume,underlying diseases,and postoperative blood pressure).This system significantly optimizes blood pressure control precision in HICH surgical patients,markedly reduces the incidence of postoperative rebleeding,effectively promotes neurological functional recovery,and decreases complications rate.关键词
高血压脑出血/层级护理/考克斯比例风险回归模型/血压/术后再出血Key words
Hypertensive intracerebral hemorrhage/Hierarchical nursing/Cox proportional hazards regression model/Blood pressure/Postoperative rebleeding
