ICU患者急性皮肤衰竭风险评估工具的构建及验证研究

doi:10.3761/j.issn.2096-7446.2025.05.001

摘要/Abstract

摘要：

目的构建ICU患者急性皮肤衰竭（acute skin failure，ASF）风险评估工具并进行验证，为评估ICU患者ASF发生风险提供科学的评估工具。方法以风险管理理论为理论基础，结合文献回顾法和德尔菲专家函询，形成初版评估工具。采用便利抽样法，选取2023年6月—7月山东省某三级甲等综合医院ICU的217例患者为调查对象，采用初版评估工具评估患者发生ASF的风险，并进行项目分析和信效度检验；选取2023年8月—2024年2月该院ICU的1 036例患者对评估工具进行预测效度检验，验证评估工具的预测价值。结果 ICU患者ASF评估工具包含6个一级指标，15个二级指标。该评估工具的Cronbach’s α系数为0.757，内容效度指数为0.940。受试者操作特征曲线下面积为0.976（95%CI：0.968~0.985），Kappa系数0.861（P<0.001），灵敏度为92.1%，特异度为95.7%；最佳截断值为12分，总分风险程度分级为低风险（12~15分）、中风险（16~20分）、高风险（21~27分），评分越高，ICU患者发生ASF的风险越高。结论该研究构建的ICU患者ASF风险评估工具信效度良好，具有较好的灵敏度和实用性，可有效预测ICU患者ASF的发生。

关键词: 重症监护病房, 急性皮肤衰竭, 风险评估, 德尔菲法, 信效度, 护理

Abstract:

Objective To develop and validate a risk assessment tool for acute skin failure in ICU patients，aiming to provide a scientific assessment tool for evaluating the risk of acute skin failure in ICU patients. Methods Based on the theory of risk management，combined with literature review and Delphi expert consultation，an initial assessment tool was formed. Using convenience sampling，217 patients in the ICU of a tertiary general hospital in Shandong Province from June to July 2023 were selected as the research subjects，and item analysis and reliability and validity tests were conducted. A preliminary validation was carried out on 1，036 patients in the ICU of the same hospital from August 2023 to February 2024 to test the predictive value of the assessment tool and verify its predictive value. Results The assessment tool for acute skin failure in ICU patients included 6 first-level indicators and 15 second-level indicators. The Cronbach’s α coefficient of the tool was 0.757，and the content validity index was 0.940. The area under the receiver operating characteristic curve was 0.976（95%CI：0.968~0.985），Kappa coefficient was 0.861（P<0.001）. with a sensitivity of 92.1% and a specificity of 95.7%. The optimal cut-off value was 12 points，and the total score risk level was classified into low risk（12~15 points），medium risk 16~20 points），high risk（21~27 points）. The higher the score，the higher the risk of acute skin failure in ICU patients. Conclusion The risk assessment tool for ICU patients developed in this study has good reliability and validity，and has good sensitivity and practicality，which can effectively predict the occurrence of acute skin failure in ICU patients.

Key words: Intensive Care Unit, Acute Skin Failure, Risk Assessment, Delphi Method, Reliability and Validation, Nursing Care

张建, 王晓萍, 史绪生, 薛雪, 盖玉彪, 高祀龙, 郭小靖, 魏丽丽. ICU患者急性皮肤衰竭风险评估工具的构建及验证研究[J]. 中华急危重症护理杂志, 2025, 6(5): 517-523.

ZHANG Jian, WANG Xiaoping, SHI Xusheng, XUE Xue, GAI Yubiao, GAO Silong, Guo Xiaojing, WEI Lili. Construction and validation of a risk assessment tool for acute skin failure in ICU patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(5): 517-523.

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参考文献 25

[1]	陈香萍, 劳月文, 张奕, 等. 重症患者急性皮肤衰竭的研究进展[J]. 中华护理杂志, 2021, 56(3):376-380. doi: 10.3761/j.issn.0254-1769.2021.03.010
	Chen XP, Lao YW, Zhang Y, et al. Research progress of acute skin failure in critically ill patients[J]. Chin J Nurs, 2021, 56(3):376-380. doi: 10.3761/j.issn.0254-1769.2021.03.010
[2]	Cohen KE, Scanlon MC, Bemanian A, et al. Pediatric skin failure[J]. Am J Crit Care, 2017, 26(4):320-328. doi: 10.4037/ajcc2017806 pmid: 28668918
[3]	许培, 吴玲玉, 马丽华, 等. 老年重症患者急性皮肤衰竭现状及危险因素分析[J]. 中华急危重症护理杂志, 2024, 5(5):401-407.
	Xu P, Wu LY, Ma LH, et al. The status and risk factors analysis of acute skin failure in critically ill elderly patients[J]. Chin J Emerg Crit Care Nurs, 2024, 5(5):401-407.
[4]	张建. ICU患者急性皮肤衰竭风险评估工具的构建及验证[D]. 青岛: 青岛大学, 2024.
	Zhang J. Construction and verification of risk assessment tool for acute skin failure in ICU patients[D]. Qingdao: Qingdao University, 2024.
[5]	张建, 刘庆伟, 薛雪, 等. 重症患者急性皮肤衰竭评估工具的研究进展[J]. 中华现代护理杂志, 2024, 30(2):267-270.
	Zhang J, Liu QW, Xue X, et al. Research progress of assessment tools for acute skin failure in critically ill patients[J]. Chin J Mod Nurs, 2024, 30(2):267-270.
[6]	洪素. 基于风险管理理论的护理不良事件预防研究:以跌倒和压疮为例[D]. 哈尔滨: 哈尔滨医科大学, 2017.
	Hong S. Study on prevention of nursing adverse events based on risk management theory:taking falls and pressure ulcers as examples[D]. Harbin: Harbin Medical University, 2017.
[7]	廖星, 胡瑞学, 李博, 等. 混合方法研究评价工具的介绍:MMAT[J]. 中国全科医学, 2021, 24(31):4015-4020. doi: 10.12114/j.issn.1007-9572.2021.00.215
	Liao X, Hu RX, Li B, et al. An introduction to mixed methods appraisal tool[J]. Chin Gen Pract, 2021, 24(31):4015-4020.
[8]	杨小辉. 成人ICU患者压力性损伤风险评估工具的构建及评价[D]. 苏州: 苏州大学, 2019.
	Yang XH. Construction and evaluation of stress injury risk assessment tool for adult ICU patients[D]. Suzhou: Soochow University, 2019.
[9]	李爽. 重症胰腺炎患者ICU过渡期护理方案的构建及应用[D]. 开封: 河南大学, 2022.
	Li S. Construction and application of ICU transitional nursing scheme for patients with severe pancreatitis[D]. Kaifeng: Henan University, 2022.
[10]	龙兴霞. ICU肠内营养患者再喂养综合征危险因素分析及风险预测模型研究[D]. 湖州: 湖州师范学院, 2021.
	Long XX. Study on risk factors and risk prediction model of re-feeding syndrome in ICU patients with enteral nutrition[D]. Huzhou: Huzhou Normal College, 2021.
[11]	Langemo DK, Brown G. Skin fails too:acute,chronic,and end-stage skin Failure[J]. Advanc Skin Wound Care, 2006, 19(4):206-211.
[12]	Falotico JM, Shinozaki K, Saeki K, et al. Advances in the approaches using peripheral perfusion for monitoring hemody namic status[J]. Front Med(Lausanne), 2020,7:614326.
[13]	王淑娟, 刘志梅, 荆晨晨, 等. 危重症病人动脉血乳酸与急性皮肤衰竭的相关性研究[J]. 护理研究, 2022, 36(24):4343-4350.
	Wang SJ, Liu ZM, Jing CC, et al. Correlation between arterial blood lactic acid and acute skin failure in critically ill patients[J]. Chin Nurs Res, 2022, 36(24):4343-4350.
[14]	陈瑞, 赖嘉华, 谢志毅, 等. 毛细血管再充盈时间测量仪在重症患者中的应用价值初探[J]. 中国急救医学, 2019, 39(10):981-986.
	Chen R, Lai JH, Xie ZY, et al. Preliminary study on the application value of capillary refill time measuring instrument in severe patients[J]. Chin J Crit Care Med, 2019, 39(10):981-986.
[15]	王敏娜, 马佳佳, 陈东莉, 等. ICU脓毒性休克患者发生急性皮肤衰竭风险预测模型构建及验证[J]. 护理管理杂志, 2024, 24(7):586-590,613.
	Wang MN, Ma JJ, Chen DL, et al. Construction and evaluation of risk prediction model for acute skin failure occurring in patients with septic shock in intensive care unit[J]. J Nurs Adm, 2024, 24(7):586-590,613.
[16]	盛楷迪, 于桂玲, 李智慧, 等. 1型糖尿病患儿照顾者照护能力量表的编制及信效度检验[J]. 中华护理杂志, 2022, 57(14):1730-1736. doi: 10.3761/j.issn.0254-1769.2022.14.010
	Sheng KD, Yu GL, Li ZH, et al. Development and reliability and validity tests of caring ability assessment scale of caregivers of children with type 1 diabetes mellitus[J]. Chin J Nurs, 2022, 57(14):1730-1736. doi: 10.3761/j.issn.0254-1769.2022.14.010
[17]	张滢滢. 成人ICU患者误吸风险评估量表的构建及评价[D]. 苏州: 苏州大学, 2020.
	Zhang YY. Construction and evaluation of risk assessment scale for inhalation of adult ICU patients[D]. Suzhou: Soochow University, 2020.
[18]	程志强, 张宝珍, 夏娇云, 等. ICU转出患者应激障碍风险预测模型的构建与验证[J]. 中华护理杂志, 2023, 58(18):2223-2229. doi: 10.3761/j.issn.0254-1769.2023.18.007
	Cheng ZQ, Zhang BZ, Xia JY, et al. Development and validation of risk prediction model for post-traumatic stress disorder in ICU transferred patients[J]. Chin J Nurs, 2023, 58(18):2223-2229. doi: 10.3761/j.issn.0254-1769.2023.18.007
[19]	王雪皎. 重症监护室特异性压力性损伤风险评估量表的汉化及应用研究[D]. 长沙: 中南大学, 2022.
	Wang XJ. Study on localization and application of risk assessment scale for specific stress injury in intensive care unit[D]. Changsha: Central South University, 2022.
[20]	欧阳艳艳, 王晓霞, 陈璟, 等. ICU转出患者认知障碍发生现状及影响因素分析[J]. 中华护理杂志, 2022, 57(24):2991-2996. doi: 10.3761/j.issn.0254-1769.2022.24.007
	Ouyang YY, Wang XX, Chen J, et al. Cognitive impairment and its influencing factors in patients transferred from ICU[J]. Chin J Nurs, 2022, 57(24):2991-2996. doi: 10.3761/j.issn.0254-1769.2022.24.007
[21]	林琦, 刘玉荣, 杨慧, 等. 肺癌患者运动训练行为感知量表的编制及信效度检验[J]. 中华护理杂志, 2024, 59(1):22-28. doi: 10.3761/j.issn.0254-1769.2024.01.003
	Lin Q, Liu YR, Yang H, et al. Development and validation of an Exercise Behavior Perception Scale for Lung Cancer Patients[J]. Chin J Nurs, 2024, 59(1):22-28. doi: 10.3761/j.issn.0254-1769.2024.01.003
[22]	Zhang ZH, Ho KM, Hong YC. Machine learning for the prediction of volume responsiveness in patients with oliguric acute kidney injury in critical care[J]. Crit Care, 2019, 23(1):112.
[24]	任昱燊. 压力性损伤风险评估工具的汉化及应用研究[D]. 天津: 天津医科大学, 2019.
	Ren YS. Study on localization and application of stress injury risk assessment tools[D]. Tianjin: Tianjin Medical University, 2019.
	荆晨晨, 王淑娟, 韩春彦, 等. 脓毒性休克病人皮肤花斑评分联合乳酸对急性皮肤衰竭的预测价值[J]. 护理研究, 2023, 37(13):2347-2351.
	Jing CC, Wang SJ, Han CY, et al. Predictive value of skin mettling score combined with lactic acid for acute skin failure in septic shock patients[J]. Chin Nurs Res, 2023, 37(13):2347-2351.
[25]	Hill R, Petersen A. Skin failure clinical indicator scale:proposal of a tool for distinguishing skin failure from a pressure injury[J]. Wounds, 2020, 32(10):272-278.