【作者】 刘琴；

【导师】 胡晓莹； 谢小华；

【作者基本信息】 南昌大学 ， 护理（专业学位）， 2021， 硕士

【副题名】以Padua风险评估量表为基础

【摘要】 目的:1.研制简单易行、科学的慢阻肺急性加重期VTE风险评估量表,为临床医护人员提供有效的评估工具。2.运用初步形成的慢阻肺急性加重期VTE风险评估量表评估临床资料,分析量表的信效度和预测效果。方法:1.通过查阅国内外相关文献以及参考我国《2018年肺血栓栓塞症诊治与预防指南》中推荐内科住院患者VTE评估使用的的Padua风险评估量表,初步拟定慢阻肺急性加重期VTE风险评估框架,运用德尔菲专家咨询法和层次分析法,对指标进行筛选、确定权重,同时进行赋值,形成初始慢阻肺急性加重期VTE风险评估量表。2.回顾性收集临床患者的资料,运用初步研制的慢阻肺急性加重期VTE风险评估量表对资料进行评估。根据临床资料和评分,通过临界比值法、相关系数法和因子分析法进行项目分析,形成修订版评估量表。分析修订版量表的信效度,绘制ROC曲线确定量表的最佳诊断阈值,检验预测效度和区分效度,运用四分位数法进行风险分层,形成慢阻肺急性加重期VTE风险评估量表。结果:1.第一阶段:通过对19名专家进行两轮函询和层次分析法,初步确定了慢阻肺急性加重期VTE风险评估指标:5个一级指标,26个二级指标。两轮专家函询的积极系数分别为95%、100%;两轮专家函询的权威系数分别为0.87、0.88,两轮专家函询的Kendall’s W为0.317～0.377,差异有统计学意义(P<0.001)。2.第二阶段:(1)通过对374例临床数据进行VTE风险评估,结合3种条目筛选方法,达到2种及以上删除标准的条目有:缺血性脑卒中、活化部分凝血活酶时间、凝血酶原时间等,予以删除,形成包含23个条目的修订版评估量表。(2)修订版评估量表的内部一致性信度Cronbach’sα系数为0.636,条目的内容效度(I-CVI)为0.830～1.000,量表的内容效度指数(S-CVI)为0.970,探索性因子分析共提取出8个公因子,累计贡献率为58.315%,因子最大载荷系数均大于0.4。量表的ROC曲线下面积AUC为0.910,约登指数YI最大值为0.666,此时的最佳临界值为7.5,敏感度、特异度分别是90.7%、75.90%,最终确定8～11分为低危;12～19分为中危;≥20分为高危。374例临床患者中,非VTE组和VTE组的量表总分的中位数(四分位间距)分别为5(3,7)分、14(10.75,19.25)分,差异有统计学意义(P<0.001)。结论:1.在Padua风险评估量表的基础上初步研制了慢阻肺急性加重期VTE风险评估量表,通过德尔菲专家咨询法和层次分析法两者相结合的方法,对条目进行筛选和赋予相应的分值,形成慢阻肺急性加重期VTE风险评估量表(初始版),包括5个一级指标,26个二级指标。2.通过对回顾性研究数据进行项目分析,对条目进行优化,形成包含23个条目的修订版评估量表,显示本量表的信效度较好。3.确定慢阻肺急性加重期VTE风险评估表的最佳诊断临界值为8分,风险分层为低危组:8～11分;中危组:12～19分;高危组:≥20分。评估表的灵敏度和特异度较高,具有较好的预测效度和区分效度,可以较好地用于临床患者的VTE风险评估。更多还原

【Abstract】 Objective:1.Develop a simple,feasible and scientific risk assessment scale for VTE in acute exacerbation of COPD to provide an effective risk assessment tool for clinical medical staff.2.The preliminary VTE risk assessment scale for acute exacerbation of COPD was used to evaluate the clinical data,and analyzed the reliability and validity of the scale and its prediction.Methods:1.The risk assessment framework for VTE in acute exacerbation of COPD was initially developed by referring to relevant domestic and foreign literatures and the Padua risk assessment scale recommended for VTE assessment in China’s 2018 Guidelines for the Diagnosis,Treatment and Prevention of Pulmonary Thromboembolism.The Delphi expert consultation method and the analytic hierarchy process were used.The indicators were screened,weights were determined,and values were assigned to form the initial VTE risk assessment scale in the acute exacerbation of COPD.2.The data of clinical patients were retrospectively collected and evaluated by using the preliminarily developed VTE risk assessment scale for acute exacerbation of COPD.According to the clinical data and scores,the method of critical ratio,correlation coefficient and factor analysis were carried out,and the revised evaluation scale was formed.The reliability and validity of the revised scale were analyzed,the ROC curve was drawn to determine the optimal diagnostic threshold of the scale,the predictive validity and discriminative validity were tested,and the quartile method was used to stratify the risks and form the VTE risk assessment scale for acute exacerbation of COPD.Results:1.Stage 1: The risk assessment indicators of VTE in acute exacerbation of COPD were preliminarily determined by two rounds of correspondence consultation with 19 experts and analytic hierarchy process(AHP): 5 first-level indicators and 26second-level indicators.The positive coefficients of two rounds of expert letter consultation were 95% and 100% respectively.The authority coefficients of the two rounds of expert letter consultation were 0.87 and 0.88 respectively,and the Kendall’s W of the two rounds of expert letter consultation was 0.317～0.377,the difference was statistically significant(P<0.001).2.Stage 2:(1)Through VTE risk assessment on 374 clinical data,combined with three screening methods of items,items that reached 2 or more deletion criteria were:ischemic stroke,activated partial thromboplastin time,prothrombin time,etc.were deleted,and a revised assessment scale containing 23 items was formed.(2)Cronbach’s α coefficient,item content validity(I-CVI)and content validity index(S-CVI)of the revised evaluation scale were 0.636,0.830～1.000,and 0.970,respectively.Seven common factors were extracted by exploratory factor analysis,and the cumulative contribution rate was 58.315%.The maximum load coefficient of all factors was greater than 0.4.The AUC under the ROC curve of the scale was 0.910,and the maximum value of Youden index was 0.666.At this time,the optimal critical value was 7.5,sensitivity and specificity were 90.7% and 75.90%,respectively.Finally,8～11 was determined as low risk.12～19 is medium risk;≥20 is classified as high risk.Among 374 clinical patients,the median total scale scores(interquartile interval)of the non-VTE group and the VTE group were 5(3,7)points and 14(10.75,19.25)points,respectively,and the difference was statistically significant.Conclusion:1.Based on Padua risk assessment scale,we developed the preliminary stage copd exacerbations VTE risk assessment scale,through the Delphi expert consultation method and analytic hierarchy process(ahp),the items were screened and assigned corresponding scores to form the VTE risk assessment scale(initial version)for acute exacerbation of COPD,including 5 first-level indicators and 26second-level indicators.2.Through item analysis on the retrospective study data,items were optimized to form a revised assessment scale containing 23 items,which showed that the reliability and validity of this scale was good.3.The optimal diagnostic cut-off value of VTE risk assessment table for acute exacerbation of COPD was 8 points,and the risk stratification was low-risk group: 8～11 points;Medium-risk group: 12～19 points;High risk group:≥20 points.The evaluation form has high sensitivity and specificity,good predictive effect and discriminative validity,and can be well used for VTE risk assessment in clinical patients.更多还原