危重症新生儿医源性皮肤损伤风险评估量表的编制及信效度检验

doi:10.3761/j.issn.1672-9234.2024.06.015

摘要/Abstract

摘要：

目的编制危重症新生儿医源性皮肤损伤风险评估量表，并检验其信效度。方法基于文献分析、半结构式访谈和专家小组讨论，结合现有的新生儿皮肤损伤风险评估量表构建条目池，经德尔菲法和预调查构建量表。采用便利取样法选取2023年1月—5月于天津市3所三级甲等医院内科NICU住院的219例新生儿为研究对象开展问卷调查，检验量表的信效度。结果最终版量表包括生理状况、医用粘胶相关性皮肤损伤风险要素、药物外渗性损伤风险要素和医疗器械相关性皮肤损伤风险要素4个维度，共13个条目。量表水平的内容效度指数为0.92，条目水平的内容效度指数为0.83~1.00；探索性因子分析结果显示，共提取4个公因子，累计方差贡献率为75.36%；量表Cronbach’s α系数为0.877，评分者间信度为0.997；量表预测危重症新生儿医源性皮肤损伤发生风险的受试者操作特征曲线下面积为0.92（P<0.001，95%CI为0.884~0.956），截断值为34.5分。结论本研究编制的危重症新生儿医源性皮肤损伤风险评估量表信效度良好，可为评估内科危重症新生儿发生医源性皮肤损伤的风险提供可靠的测评工具。

关键词: 重症监护室, 新生儿, 皮肤损伤, 医源性, 量表, 信度, 效度

Abstract:

Objective To develop a Iatrogenic Skin Injury Risk Assessment Scale for Critical Neonates and to test its reliability and validity in medical neonatal intensive care unit（NICU）. Methods The initial scale was developed through literature analysis，semi-structruced interview，group discussion，Delphi and pre-survey. From January 2023 to May 2023，219 neonates in medical NICU from three tertiary A hospitals in Tianjin were selected for questionnaire survey to test the reliability and validity of the scale. Results The final version of the scale contains 13 items in 4 dimensions including physiological situation，medical adhesive-related injury risk elements，drug extravasation injury risk factors，and medical device-related stress injury risk elements. The cumulative variance contribution rate of the scale was 75.36%. The content validity indexes at the scale level and the item level were 0.92 and 0.83~1.00 respectively. The Cronbach’s α coefficient and inter-rater reliability of the scale was 0.877 and 0.997. The area under the operating characteristic curve of the scale for predicting the risk of iatrogenic skin injuries in critical neonates was 0.92（P<0.001，95%CI was 0.884~0.956） and the cut-off value was 34.5. Conclusion The scale constructed in this study has good reliability and validity，and it can be used to access the risk of iatrogenic skin injuries in neonates in medical NICU.

Key words: Intensive Care Units, Neonatal, Iatrogenic Skin Injuries, Scale, Reliability, Validity

张学颖, 张晓翠, 尹雪梅, 夏欣华, 王莹, 王蓓, 朱红. 危重症新生儿医源性皮肤损伤风险评估量表的编制及信效度检验[J]. 中华护理教育, 2024, 21(6): 731-737.

ZHANG Xueying, ZHANG Xiaocui, YIN Xuemei, XIA Xinhua, WANG Ying, WANG Bei, ZHU Hong. Development and validation of the Iatrogenic Skin Injury Risk Assessment Scale for Critical Neonates[J]. Chinese Journal of Nursing Education, 2024, 21(6): 731-737.

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参考文献 28

[1]	新生儿医源性皮肤损伤的评估要点和预见性护理的专家共识工作组, 海峡两岸医药卫生交流协会第一届新生儿专业委员会新生儿护理与护理管理学组. 新生儿医源性皮肤损伤的评估要点和预见性护理的专家共识[J]. 中国循证儿科杂志, 2020, 15(3):161-165.
[2]	陆春梅, 季福婷, 吕天婵, 等. 新生儿重症监护室医源性皮肤损伤多中心横断面调查[J]. 中国循证儿科杂志, 2022, 17(2):122-127.
	Lu CM, Ji FT, Lü TC, et al. A national multicenter cross-sectional survey of iatrogenic skin injury in neonates in NICU[J]. Chin J Evid Based Pediatr, 2022, 17(2):122-127.
[3]	杨童玲, 胡晓静, 吕天婵. NICU患儿医源性皮肤损伤的现况调查[J]. 中华护理杂志, 2019, 54(9):1369-1372. doi: 10.3761/j.issn.0254-1769.2019.09.017
	Yang TL, Hu XJ, Lü TC. Investigation of iatrogenic skin injury in infants in neonatal intensive care unit[J]. Chin J Nurs, 2019, 54(9):1369-1372. doi: 10.3761/j.issn.0254-1769.2019.09.017
[4]	谢彬艳, 叶茹明, 李婉婷. NICU患儿医源性皮肤损伤及与临床特征的关系[J]. 实用临床医学, 2020, 21(7):79-82.
[5]	Meszes A, Tálosi G, Máder K, et al. Lesions requiring wound management in a central tertiary neonatal intensive care unit[J]. World J Pediatr, 2017, 13(2):165-172. doi: 10.1007/s12519-016-0070-6 pmid: 27878785
[6]	Csoma ZR, Meszes A, ábrahám R, et al. Iatrogenic skin disor-ders and related factors in newborn infants[J]. Pediatr Dermatol, 2016, 33(5):543-548.
[7]	Ligi I, Arnaud F, Jouve E, et al. Iatrogenic events in admitted neonates:a prospective cohort study[J]. Lancet, 2008, 371(9610):404-410.
[8]	Tavares IVR, Silva DCZ, Silva MR, et al. Patient safety in the prevention and care of skin lesions in newborns:integrative review[J]. Rev Bras Enferm, 2020, 73(suppl 4):e20190352.
[9]	刘慧娟, 梁爽, 陈华, 等. 新生儿皮肤损伤风险评估研究进展[J]. 中国护理管理, 2019, 19(11):1729-1733.
[10]	黄小夏, 张丽萍, 陈艳, 等. 新生儿医用粘胶剂相关性皮肤损伤风险评估量表的编制与信效度检验[J]. 中华护理杂志, 2019, 54(3):380-384. doi: 10.3761/j.issn.0254-1769.2019.03.010
	Huang XX, Zhang LP, Chen Y, et al. Development of Neonate Medical Adhesive Related Skin Injury Risk Assessment Scale and assessment of its validity and reliability[J]. Chin J Nurs, 2019, 54(3):380-384. doi: 10.3761/j.issn.0254-1769.2019.03.010
[11]	桂园园. NICU新生儿医用粘胶相关性皮肤损伤风险评估量表的研制及评价[D]. 沈阳: 中国医科大学, 2017.
	Gui YY. Development and evaluation of NICU Neonatal Medical Viscose-related Skin Injury Risk Assessment Scale[D]. Shenyang: China Medical University, 2017.
[12]	刘慧娟, 陈华, 杨园园, 等. 新生儿皮肤损伤风险评估工具的构建[J]. 中国护理管理, 2019, 19(12):1785-1790.
	Liu HJ, Chen H, Yang YY, et al. Development of the neonatal skin injury risk assessment tool with Delphi method[J]. Chin Nurs Manag, 2019, 19(12):1785-1790.
[13]	Huffines B, Logsdon MC. The Neonatal Skin Risk Assessment Scale for predicting skin breakdown in neonates[J]. Issues Compr Pediatr Nurs, 1997, 20(2):103-114. doi: 10.3109/01460869709026881 pmid: 9423386
[14]	吴玉洁, 鲁萍, 吕俊英, 等. 汉化版Neonatal/Infant Braden Q Scale在NICU新生儿压力性损伤风险评估中的应用[J]. 温州医科大学学报, 2019, 49(7):538-541,544.
	Wu YJ, Lu P, Lü JY, et al. Chinese version of Neonatal/Infant Braden Q Scale in the assessment of neonatal pressure injury risk in NICU[J]. J Wenzhou Med Univ, 2019, 49(7):538-541,544.
[15]	Lund CH, Osborne JW, Kuller J, et al. Neonatal skin care:clinical outcomes of the AWHONN/NANN evidence-based clinical practice guideline. Association of Women’s Health,Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses[J]. J Obstet Gynecol Neonatal Nurs, 2001, 30(1):41-51. pmid: 11277161
[16]	Curley MAQ, Hasbani NR, Quigley SM, et al. Predicting pressure injury risk in pediatric patients:the Braden QD Scale[J]. J Pediatr, 2018, 192:189-195.e2.
[17]	Diamond IR, Grant RC, Feldman BM, et al. Defining consen-sus:a systematic review recommends methodologic criteria for reporting of Delphi studies[J]. J Clin Epidemiol, 2014, 67(4):401-409. doi: 10.1016/j.jclinepi.2013.12.002 pmid: 24581294
[18]	吴明隆. 问卷统计分析实务:SPSS操作与应用[M]. 重庆: 重庆大学出版社, 2010.
[19]	黄庆萍, 张建荣, 黄艳芳, 等. ICU医疗器械相关性压力性损伤风险评估量表构建与分析[J]. 护士进修杂志, 2018, 33(19):1743-1746.
	Huang QP, Zhang JR, Huang YF, et al. Construction and ana-lysis of ICU Risk Assessment Scale for medical device related stress injury[J]. J Nurses Train, 2018, 33(19):1743-1746.
[20]	黄晓睿, 周文姬, 肖苑红, 等. 新生儿静脉输液外渗风险因素分析及预防[J]. 中国临床护理, 2020, 12(2):169-171. doi: 10.3969/j.issn.1674-3768.2020.02.022
	Huang XR, Zhou WJ, Xiao YH, et al. Risk factors and prevention of extravasation of venous transfusion of neonates[J]. Chin Clin Nurs, 2020, 12(2):169-171. doi: 10.3969/j.issn.1674-3768.2020.02.022
[21]	袁红连, 熊芬, 刘颖. 静脉输液新生儿外渗发生情况调查及其相关影响因素分析[J]. 中国医学创新, 2022, 19(20):77-80.
	Yuan HL, Xiong F, Liu Y. Investigation on occurrence of extravasation in newborns with intravenous infusion and analysis of its related influencing factors[J]. Med Innov China, 2022, 19(20):77-80.
[22]	常敏, 尚文, 赵晓娜, 等. 新生儿重症监护室早产儿医用粘胶相关性皮肤损伤风险评估表的编制[J]. 循证护理, 2023, 9(10):1883-1887.
	Chang M, Shang W, Zhao XN, et al. Development of Medical Adhesive Related Skin Injury Risk Assessment Scale for premature infants in NICU[J]. Chin Evid Based Nurs, 2023, 9(10):1883-1887.
[23]	Chamblee TB, Pasek TA, Caillouette CN, et al. CE:how to predict pediatric pressure injury risk with the Braden QD Scale[J]. Am J Nurs, 2018, 118(11):34-43. doi: 10.1097/01.NAJ.0000547638.92908.de pmid: 30325747
[24]	失禁护理专业委员会中华护理学会伤口造口. 器械相关压力性损伤预防指南(2020版)[J]. 中华护理杂志, 2020, 55(S1):115-121.
[25]	Jackson D, Sarki AM, Betteridge R, et al. Medical device-re-lated pressure ulcers:a systematic review and meta-analysis[J]. Int J Nurs Stud, 2019, 92:109-120. doi: S0020-7489(19)30037-9 pmid: 30782513
[26]	秦光雅, 乔远静, 李丹丹, 等. NICU医疗器械相关压力性损伤的现状及干预措施的研究进展[J]. 护士进修杂志, 2023, 38(3):224-228.
	Qin GY, Qiao YJ, Li DD, et al. Current situation of stress injury related to medical devices in NICU and its interven-tion progress[J]. J Nurses Train, 2023, 38(3):224-228.
[27]	史静琤, 莫显昆, 孙振球. 量表编制中内容效度指数的应用[J]. 中南大学学报(医学版), 2012, 37(2):49-52.
[28]	李灿, 辛玲. 调查问卷的信度与效度的评价方法研究[J]. 中国卫生统计, 2008, 25(5):541-544.