摘要
目的分析基于考克斯比例风险回归模型(Cox风险模型)的层级护理干预对高血压脑出血(HICH)手术患者术后再出血的影响。方法选取昆山市中医医院2021年1月至2023年6月收治的136例HICH手术患者作为建模队列,通过Cox风险模型分析,筛选出术后再出血的独立危险因素,并据此构建个体化风险积分系统进行风险分层。在此基础上,选取2023年7月至2024年11月收治的82例HICH手术患者作为验证队列,按随机数表法分为对照组(41例,采用常规护理)和观察组(41例,采用基于Cox风险模型的层级护理)。比较两组患者术后即刻和术后12 h内血压控制情况、术后7 d再出血率、干预前和干预2周后的神经功能[国立卫生研究院卒中量表(NIHSS)评分]及干预期间并发症发生情况。结果根据Cox风险模型分析发现,年龄、血肿量、患有基础疾病、术后血压是HICH患者术后再出血的独立危险因素(P<0.05);两组患者术后即刻血压比较差异无统计学意义(P>0.05);观察组术后12 h内的血压峰值及其波动幅度均低于对照组(P<0.05);观察组术后7 d内再出血率显著低于对照组(2.44%vs.17.07%,P<0.05);干预2周后两组NIHSS评分均降低,且观察组低于对照组(P<0.05);观察组并发症发生率低于对照组(4.88%vs.19.52%,P<0.05)。结论基于Cox风险模型构建的层级护理干预体系,通过整合年龄、血肿量、基础疾病及术后血压四项独立危险因素进行动态风险分层,显著优化了HICH手术患者的血压控制精度,并显著降低术后再出血发生率,有效促进神经功能恢复,减少并发症发生。
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.
作者
韦艳
陆燕文
阮晴瑛
WEI Yan;LU Yanwen;RUAN Qingying(Department of Neurosurgery,Kunshan Traditional Chinese Medicine Hospital,Kunshan 215300,China)
出处
《医药高职教育与现代护理》
2026年第1期52-56,共5页
Medical Higher Vocational Education and Modern Nursing
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
Hypertensive intracerebral hemorrhage
Hierarchical nursing
Cox proportional hazards regression model
Blood pressure
Postoperative rebleeding
