ABSTRACT
Objective To investigate the main risk factors of respiratory complications in patients with cervical spinal cord injury so as to provide reference for early nursing assessment and personalized nursing intervention model. Methods A retrospective case series study was conducted on the clinical data of 303 patients with cervical spinal cord injury admitted to the Third Hospital of Hebei Medical University between January 2015 and September 2016. There were 248 males and 55 females, aged (44.9 ±13.8)years (range, 14-70 years). There were 109 cases at fracture site C14 and 194 cases at C5-8. According to ASIA classification, 131 cases were grade A, 26 cases grade B, 42 cases grade C, and 104 cases grade D. The duration from injury to operation was (23.2 ± 69.9) hours (range, 6-48 hours). Univariate analysis was performed on the risk factors of respiratory complications, including gender, age (14-54, 55-65, and 66-70 years old), occupation, hospital stay, smoking history, previous history, ASIA grade (grades A to D), injury cause, complications (abdominal distension, hyponatremia, hypoproteinemia, and anemia). Multivariate logistic regression was used to analyze the significant risk factors in the univariate analysis so as to further identify risk factors associated with respiratory complications. Results Univariate analysis showed that age (55-65 and 66-70 years), ASIA grade A, ASIA grade B, smoking history, injury cause, complications (abdominal distension, hyponatremia, hypoproteinemia, and anaemia) were related to respiratory complication of patients with cervical spinal cord injury (P ＜0.05). The gender, occupation, length of hospital stay, and previous history were not associated with respiratory complications of patients with cervical spinal cord injury (P＞0.05). Logistic regression analysis showed that age between 55 and 65 years (OR = 3.989, P ＜ 0.05), age between 66 and 70 years(OR =0.301, P＜0.05), AISA grade A (OR=30.300, P＜0.05), ASIA grade B (OR =5.784, P ＜0.05), smoking history (OR=5.238, P ＜0.05), abdominal distension (OR = 1.975, P＜0.05), hypoproteinemia (OR =6.212, P ＜ 0.05), and hyponatremia (OR =3.233 ＜0.05) were independent risk factors for respiratory complications in patients with spinal cord injury. Except for ASIA classification, other factors might be easily ignored by doctors and nurses, leading to poor prognosis of patients. Conclusions Age (above 55 years), ASIA grades A and B, smoking history, abdominal distention, hypoproteinemia, and hyponatremia are the risk factors of respiratory complications in patients with cervical spinal cord injury. Based on the results, early nursing assessment can be carried out and personalized nursing measures can be taken to reduce the incidence of respiratory complications. It can also provide reference for constructing standardized nursing intervention model.
ABSTRACT
Objective To explore clinical practice value of Disease Severity Evaluation Scale (DSAS), and divide patient's nursing level according to the results of DSAS. Methods The assessment group was set up for evaluation of the scale, DSAS was used to determine the nursing level of 3 713 hospitalized patients (age > 18 years old) from 17 clinical departments, from April to May 2014. Results Nursing level determined by DSAS was compared with the standard nursing level, kappa coefficient was 0.72, P < 0.05, suggesting that the consistency was better. According to the kappa coefficient, 17 clinical departments could be divided into three categories, namely the applicability of DSAS were different in different departments. Conclusions DSAS can be used as a objective basis for division of nursing level and has a certain clinical significance. But in order to make it guide clinical work better, scoring system with department characteristic should be developed on the basis of DSAS.