3种压疮危险评估表对脊髓损伤病人压疮预测效果的比较研究

[目的]比较Braden评估表、Norton评估表、Waterlow评估表3种压疮危险评估表对脊髓损伤病人的压疮预测效果。[方法]选取脊髓损伤病人155例,运用3种量表对每例病人进行连续评估,计算各量表的灵敏度、特异度、预测值和ROC曲线下面积。[结果]3种量表的最佳临界值分别为14分、14分和20分。ROC曲线下面积分别为0.891、0.850和0.798。[结论]Braden评估表对脊髓损伤病人压疮的预测效果较好。     

3种评估表对神经内科住院病人压疮预测效果的比较研究

[目的]比较Braden Scale、Waterlow Scale和华西医科大学评估表(WCUMSS cales)3种压疮危险评估量表对神经内科住院病人压疮的预测效果。[方法]选取神经内科住院病人439例,3名护士分别运用3种评估量表同时对每例病人进行动态评估,计算各量表的灵敏度、特异度、阳性预测值、阴性预测值、ROC曲线下面积。[结果]3种评估量表的最佳临界值分别为17分、10分、22分,WCUMS Scale评估表曲线下面积>0.9。[结论]WCUMS Scale评估表对神经内科住院病人压疮预测效果较好。     

两种压疮危险评估表预测效果的比较研究

[目的]测量并比较Waterlow压疮危险评估表和Braden修订版压疮危险评估表的预测效果。[方法]分别用两种评估表对332例病人进行评分，分析不同临界值时敏感性、特异性、阳性预测价值、阴性预测价值。[结果]Braden修订版压疮危险评估表以19分为临界值、Waterlow压疮危险评估表以15分为临界值时敏感性、特异性、阳性预测价值、阴性预测价值等指标间能达到较好的平衡，且Braden修订版压疮危险评估表各指标均大于Waterlow压疮危险评估表；Braden修订版压疮危险评估表的ROC曲线下面积略高于waterlow压疮危险评估表。[结论]Braden修订版压疮危险评估表和Waterlow压疮危险评估表都有较好的预测效果，尤其以Braden修订版效果更优。     

两种压疮危险评估表预测效果的比较研究

[目的]测量并比较Waterlow压疮危险评估表和Braden修订版压疮危险评估表的预测效果。[方法]分别用两种评估表对332例病人进行评分,分析不同临界值时敏感性、特异性、阳性预测价值、阴性预测价值。[结果]Braden修订版压疮危险评估表以19分为临界值、Waterlow压疮危险评估表以15分为临界值时敏感性、特异性、阳性预测价值、阴性预测价值等指标间能达到较好的平衡,且Braden修订版压疮危险评估表各指标均大于Waterlow压疮危险评估表;Braden修订版压疮危险评估表的ROC曲线下面积略高于Waterlow压疮危险评估表。[结论]Braden修订版压疮危险评估表和Waterlow压疮危险评估表都有较好的预测效果,尤其以Braden修订版效果更优。     

两种评估量表对肿瘤病人压疮评价的比较研究

[目的]比对Braden评估量表与Waterlow评估量表测定肿瘤内科病人压疮判别的效果,确定最佳临界值。[方法]运用Braden评估表与Waterlow评估表分别对350例肿瘤内科病人进行评估,计算两种评估量表的敏感度、特异度、阳性预测值、阴性预测值、ROC曲线下面积及约登指数。[结果]本组压疮识别率为15.71%,Braden评分表、Waterlow评估表最佳临界值分别为16分、13分,Braden评估表的敏感度、特异度、阳性预测值、阴性预测值、ROC曲线下面积及约登指数分别为63.64%、80.68%、38.00%、92.20%、0.662、0.443,Waterlow评估表的敏感度、特异度、阳性预测值、阴性预测值、ROC曲线下面积及约登指数分别为89.09%、64.41%、31.80%、96.90%、0.831、0.535。[结论]Waterlow评估量表对肿瘤内科病人压疮判别的效果较好。     

3种评估表对住院老年人压疮预测能力的比较研究

目的 比较Norton、Braden和Waterlow 3种量表对老年人压疮的预测效果.方法 选取老年住院患者271例,运用3种量表对每例患者进行连续评估,计算各量表的灵敏度、特异度、预测值和ROC曲线下面积.结果 3种量表的最佳临界值分别为14、17和15分,仅Waterlow量表的ROC曲线下面积大于0.5.结论 Waterlow量表对老年人院内压疮的预测效果较好.     

Braden压疮危险因素评估量表对基层医院危重病人的适用性研究

[目的]探讨Braden压疮危险因素评估量表对基层医院危重病人压疮评估的预测效力。[方法]采用日常活动能力分类量表、Braden压疮危险因素评估量表对74例危重病人如严重创伤、神经损伤、昏迷、死亡病人进行评估。[结果]日常活动能力分类量表评分3分～5分,Braden压疮危险因素评估量表6个条目平均分为2.36分～3.06分,压疮发生率为8.1%,Braden压疮危险因素评估量表临界值为14分时灵敏度为85.1%、特异度为93.2%、阳性预测值为33.4%、阴性预测值为98.7%。[结论]危重病人病情危重度越高,Braden压疮危险因素评估量表临界值取14分时其灵敏度和特异度较好;Braden压疮危险因素评估量表对我院危重病人的压疮预测效果较好。     

3种压疮危险评估表信效度的比较研究

[目的]比较和评价Braden、Norton和Waterlow 3种压疮危险评估量表在消化系疾病老年病人中应用的信效度.[方法]选取某三级甲等医院消化科入院前未发生压疮的老年病人258例,运用3种量表连续评估病人的压疮危险,采用内容效度指数、因子分析法、ROC曲线等方法评价比较3种量表的效度,用Cronbach's α系数和Pearson 相关系数评价3种量表的内部一致性信度.[结果]Braden、Norton和Waterlow量表内容效度指数分别为0.87、0.80、0.85;KMO值分别为:0.752、0.792、0.604;因子分析得到的方差贡献率分别为68.68%、58.05%、68.04%.3种量表诊断预测价值尚可,但综合几项指标,Waterlow量表对消化系疾病老年病人压疮的预测效果最好,最佳临界值推荐19分.Cronbach's α系数结果显示Braden量表在3种量表中内部一致性最高为0.799,其次是Norton量表为0.785,最低的是Waterlow量表为0.361.条目与总分相关系数分析Braden和Norton量表条目相关适宜,Waterlow量表相关系数较低.[结论]Braden和Norton量表的内部一致性较高,Waterlow量表由于设计的特殊性使其内部一致性较低.3种量表的内容效度和结构效度总体良好、预测效度以Waterlow量表最佳.提示可以Waterlow量表为基准,调整压疮危险因素的有关条目,研究更为准确适合消化系统疾病老年病人的压疮预测工具.     

Braden压疮危险因素评估量表对基层医院危重病人的适用性研究

[目的]探讨Braden压疮危险因素评估量表对基层医院危重病人压疮评估的预测效力.[方法]采用日常活动能力分类量表、Braden压疮危险因素评估量表对74例危重病人如严重创伤、神经损伤、昏迷、死亡病人进行评估.[结果]日常活动能力分类量表评分3分～5分,Braden压疮危险因素评估量表6个条目平均分为2.36分～3.06分,压疮发生率为8.1%,Braden压疮危险因素评估量表临界值为14分时灵敏度为85.1%、特异度为93.2%、阳性预测值为33.4%、阴性预测值为98.7%.[结论]危重病人病情危重度越高,Braden压疮危险因素评估量表临界值取14分时其灵敏度和特异度较好;Braden压疮危险因素评估量表对我院危重病人的压疮预测效果较好.     

2种压疮评估量表在患儿中的应用研究

目的 评价并比较Braden Q和Braden 2种压疮评估量表在儿科重症患者中的应用效果,探索区分患儿发生压疮风险的临界值.方法 采用多中心前瞻性队列研究设计,研究地点为3家儿童医院的重症监护室,派遣2名临床护士充当数据收集员,分别负责量表评分和皮肤评估,两者分别独立进行.结果 本次研究收集样本145例,实际发生压疮9例,发生率为6.2%.Braden Q量表和Braden量表的预测临界值分别是17分和14分;而两者的ROC曲线(受试者工作特征曲线)下面积分别为0.481和0.398.结论 Braden Q量表更加适用于儿科患者,且需要进一步研究改进量表.     

Intracranial pressure. Intracranial pressure monitoring

Based on the data on the current literature, the authors present the basic physiological and pathophysiological aspects of measurement of intracranial pressure and discuss indications for its monitoring and clinical value.     

Plasma osmotic pressure and oncotic pressure

Water distribution in the body fluid is controlled by osmotic pressure and oncotic pressure of plasma. Lower plasma osmotic pressure induces intracellular edema, while lower plasma oncotic pressure induces extracellular edema. The increase in osmo-active substance in plasma induces increase in plasma volume (or extracellular fluid), and then results in extracellular edema.     

Systolic pressure variation and pulse pressure variation during modifications of arterial pressure

OBJECTIVE: This study was performed to investigate the effect of vasopressor therapy on systolic pressure variation (SPV) and pulse pressure variation (PPV) compared to experimentally measured left ventricular stroke volume variation (SVV). DESIGN AND SETTING: Prospective study in a university laboratory. SUBJECTS: Twelve anesthetized and mechanically ventilated pigs. INTERVENTIONS: Increase in mean arterial pressure (by 100%) using phenylephrine and decrease (by 38%) using adenosine. MEASUREMENTS AND RESULTS: SPV and PPV were calculated and compared to SVV derived from aortic blood flow measurements. SPV was significantly affected by changes in arterial pressure [4.6% (1.5) vs. 6.3% (2.1), p[Symbol: see text]<[Symbol: see text]0.05, increased vs. decreased arterial pressure], whereas PPV did not change during modifications of arterial pressure. During baseline conditions and decreased afterload, correlation with SVV was good both for SPV (r[Symbol: see text]=[Symbol: see text]0.892 and r[Symbol: see text]=[Symbol: see text]0.859, respectively) and for PPV (r[Symbol: see text]=[Symbol: see text]0.870 and r[Symbol: see text]=[Symbol: see text]0.871, respectively) (all p[Symbol: see text]<[Symbol: see text]0.001). Correlation with SVV was only moderate during increased arterial pressure (r[Symbol: see text]=[Symbol: see text]0.683 for SPV and r[Symbol: see text]=[Symbol: see text]0.732 for PPV, p[Symbol: see text]<[Symbol: see text]0.05). CONCLUSION: For guiding fluid therapy in patients under vasopressor support, PPV seems superior to SPV.     

Pulmonary artery pressure versus pulmonary capillary wedge pressure and central venous pressure in shock

Evidence is presented from 43 dogs and 30 patients that under conditions of severe hemorrhagic, traumatic or septic shock, there may be partial obstruction of the pulmonary microcirculation due to disseminated intravascular coagulation (DIC) particularly in the pulmonary venules. This may cause the left atrial pressure to fall and the pulmonary artery pressure to rise, in some cases drastically. Pulmonary edema may result. This dangerous rise in pulmonary artery pressure is not reflected by the wedged pulmonary artery catheter which will monitor only the status of the left heart. Central venous pressure (CVP) may remain within normal limits even after pulmonary artery pressure has risen to dangerous levels with the development of pulmonary edema. It is only with right ventricle failure against the high pulmonary pressure that CVP rises. It is concluded that pulmonary artery pressure measurements are very important in monitoring intravenous fluid administration in severe shock. Wedged pulmonary artery pressures monitor the left heart but may be misleading if taken alone. Central venous pressure gives a delayed response to fluid overload.     

Intracranial pressure and cerebral perfusion pressure in near-drowning

Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were strictly controlled in 11 pediatric victims of near-drowning. Three outcome groups were defined: complete recovery, persistent vegetative state, and death. In the early postimmersion phase (first 72 h), CPP was consistently above 50 mm Hg in all patients. There were occasional, nonrepetitive, and easily controllable ICP spikes above 15 mm Hg in three patients from each group. Repeated ICP spikes above 15 mm Hg were observed in some patients with adverse outcome only after 72 h. Successful control of ICP and CPP did not ensure intact survival, and sustained late intracranial hypertension is more likely a sign of profound neurologic insult rather than its cause.     

Heel pressure ulcers and ankle brachial pressure index

There is a substantial body of literature that emphasises the importance of measuring ankle brachial pressure index (ABPI) as part of an holistic assessment for leg ulcers (Scottish Intercollegiate Guideline Network, 1998). However, there is a paucity of research-based evidence to indicate the importance of measuring ABPI as part of an holistic assessment for patients who develop pressure ulcers on their heels. (ABPI is a simple, non-invasive method of identifying arterial insufficiency within a limb.) The importance of identifying the presence of peripheral vascular disease (PVD) in patients who develop pressure ulcers on their heels is discussed, as is the argument for measuring ABPI as part of an holistic assessment for heel ulceration before planning the wound management.     

Effect of positive end-expiratory pressure on intra-abdominal pressure

Massive elevation of intra-abdominal pressure (IAP) causes renal, cardiovascular, and respiratory dysfunction. Positive end-expiratory pressure (PEEP) markedly increases the detrimental effect of IAP on the cardiovascular system. The purpose of this study was to determine the effect of PEEP on IAP. In 15 patients requiring mechanical ventilation, IAP was measured, after 15-minute equilibration intervals, at PEEP levels of 0, 5, 10, and 15 cm H2O. Parametric analysis with multiple paired t tests and nonparametric analysis with Spearman's rho and Kendall's tau tests were used to determine correlation between PEEP and IAP. All patients were male. The mean age was 39 years (range, 18-77). Ten patients had just had laparotomy. No correlation was found between PEEP and IAP. We conclude that PEEP of 15 cm H2O or less has no effect on IAP, and we discuss the clinical implications.     

Positive end-expiratory pressure increases intraocular pressure in cats

BACKGROUND AND METHODS: The purpose of the present study was to examine the effect of various levels of positive end-expiratory pressure on intraocular pressure in cats. Fourteen healthy adult cats (2.6 to 3.7 kg) without evidence of ocular disease were anesthetized with pentobarbital, paralyzed, and placed on mechanical ventilation. Direct continuous measurements of heart rate (HR), mean arterial pressure (MAP), CVP, CSF pressure, and intraocular pressure were recorded at zero end-expiratory pressure, and at 5, 10, and 15 cm H2O positive end-expiratory pressure, applied in random order. MAIN RESULTS: There were no significant changes in pHa, Paco2, HR, MAP, hematocrit, and temperature. Intraocular pressure increased significantly from 17 (during zero end-expiratory pressure) to 20 mm Hg at 10 cm H2O positive end-expiratory pressure; at 15 cm H2O positive end-expiratory pressure, intraocular pressure increased significantly to 21 mm Hg. CVP and CSF pressure increased significantly in parallel with intraocular pressure at 5, 10, and 15 cm H2O positive end-expiratory pressure. CONCLUSIONS: We speculate that similar responses occur in man, and may be undesirable in patients with already increased intraocular pressure, when higher levels of positive end-expiratory pressure are used.