基于思维导图联合定量化预测模型对缺血性脑卒中合并吞咽障碍病人的护理实践

周南香; 冯国琴; 刘美华; 明雨雁; 李浩; 吴玉琴; 于小敏; 钱志慧

doi:10.13898/j.cnki.issn.1000-2200.2021.11.034

基于思维导图联合定量化预测模型对缺血性脑卒中合并吞咽障碍病人的护理实践

Nursing practice of the mind mapping combined with quantitative prediction model in patients with ischemic stroke complicated with dysphagia

摘要

摘要:
目的探讨基于思维导图联合定量化预测模型对缺血性脑卒中合并吞咽障碍病人的护理效果。
方法选取缺血性脑卒中病人357例作为研究对象，采用留一法将病人分为建模集（n=283）和验证集（n=74），回顾性分析建模集病人的临床资料，分析病人发生卒中后吞咽障碍的危险因素，并建立相关列线图预测模型和思维导图。
结果年龄≥ 60岁、高血压、糖尿病、脑干梗死、NHISS评分≥ 12分、GCS评分 < 10分均为缺血性脑卒中后吞咽障碍的独立危险因素（P < 0.05~P < 0.01）。基于筛选出危险因素建立列线图预测模型，建模集和验证集的C-index指数分别为0.816（95% CI：0.761~0.849）和0.782（95% CI：0.736~0.818），校正曲线均与标准曲线拟合较好，AUC分别为0.882和0.822，表明该列线图模型具有良好的预测能力；并借助思维导图清晰展现危险指标和危险分层。
结论缺血性脑卒中后吞咽障碍的危险因素较多，本研究基于危险因素建立的列线图模型具有良好的预测能力，联合思维导图有助于护理人员记忆和理解模型的临床意义。

Abstract:
ObjectiveTo explore the nursing effects of the mind mapping combined with quantitative prediction model in patients with ischemic stroke complicated with dysphagia.
MethodsA total of 357 patients with ischemic stroke were divided into the modeling set(n=283) and validation set(n=74).The clinical data of the modeling set were retrospectively analyzed, the risk factors of dysphagia after stroke were analyzed, and the relevant nomogram prediction model and mind mapping were established.
ResultsThe age ≥ 60 years, hypertension, diabetes, brainstem infarction, NHISS score ≥ 12 and GCS score < 10 were the independent risk factors of dysphagia after ischemic stroke(P < 0.05 to P < 0.01).A nomogram prediction model was established according to the screening out risk factors, the C-index indexes of the modeling set and validation set were 0.816(95% CI: 0.761-0.849) and 0.782(95% CI: 0.736-0.818), respectively.The calibration curves fit well with the standard curve, and the AUC were 0.882 and 0.822, respectively.These indicated that the nomogram model had good predictive ability, and the mind mapping could clearly show the risk indicators and risk stratifications.
ConclusionsThere are many risk factors for dysphagia after ischemic stroke.The nomogram model established in this study based on the risk factors has good predictive ability, and which combined with the mind mapping can help nurses remember and understand the clinical significance of the model.

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