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护理学报 ›› 2021, Vol. 28 ›› Issue (4): 67-72.doi: 10.16460/j.issn1008-9969.2021.04.067

• 妇产科护理 • 上一篇    下一篇

高危孕产妇病情预警评估表的构建及信效度检验

夏杰1,2, 段霞3, 张佳男4, 于婵5, 王可可4   

  1. 1.同济大学医学院,上海 200092;
    2.上海建桥学院,上海 201306;
    3.同济大学附属第一妇婴保健院,上海 201204;
    4.同济大学附属第十人民医院,上海 200072;
    5.上海市第一人民医院,上海 200080
  • 收稿日期:2020-07-15 出版日期:2021-02-25 发布日期:2021-03-12
  • 通讯作者: 段霞（1983-）,女,湖南常德人,博士,副主任护师,硕士研究生导师。E-mail:bamboo-714@163.com
  • 作者简介:夏杰（1979-）,女,河北承德人,硕士,副主任护师。
  • 基金资助:
    国家自然科学基金（71603183）

Construction of Early Warning Assessment Scale for High-risk Pregnant Women and Its Reliability and Validity

XIA Jie1,2, DUAN Xia3, ZHANG Jia-nan4, YU Chan5, WANG Ke-ke4   

  1. 1. School College of Medicine, TongjiUniversity, Shanghai 200092, China;
    2. Shanghai Jian QiaoUniversity, Shanghai 201306,China;
    3. Maternal and Infant Health Care Hospital Affiliated to TongjiUniversity, Shanghai 201204, China;
    4. the 10th People's Hospital Affiliated to TongjiUniversity, Shanghai 200072, China;
    5. Shanghai General Hospital, Shanghai 200080, China
  • Received:2020-07-15 Online:2021-02-25 Published:2021-03-12

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摘要： 目的 研制适合我国临床使用的高危孕产妇病情预警评估表,检验评估表的信效度和对病情的预测效能。方法 通过文献研究、德尔菲专家咨询法,形成高危孕产妇病情预警评估表初稿;应用评估表对150例入院高危孕产妇进行评估,检验评估表的信度和效度,并分析其对高危孕产妇发生病危/病重的预测效能。结果 高危孕产妇病情预警评估表包括4个维度,23个条目;评定者间信度（intra-class correlation coefficient,ICC）为0.905,95%可信区间（confidence interval,CI）为0.855~0.945;内容效度比（content validity ratio,CVR）平均值为0.96,评估表灵敏性为92.5%,特异度为68.2%,阳性预测值为51.4%,阴性预测值为97.4%,阳性似然比为18.00,阴性似然比为0.53,约登指数为0.61,受试者工作特征曲线下面积（area under the receiver operating characteristic curve,AUROC）为0.803;预测病危/病重的AUROC为0.719,灵敏性85.7%,特异度为58.1%,阳性似然比为10.23,阴性似然比为0.64,预测效果较好。结论 本研究构建的高危孕产妇病情预警评估表具有较好的信度和效度,对发生产科急性事件和产科危重症的预测效果好,可作为临床高危孕产妇病情评估的工具,为高危孕产妇病情的早期预警评估提供依据。

关键词: 高危孕产妇, 早期预警, 评估, 信度, 效度

Abstract: Objective To develop an early warning assessment scale for high-risk pregnant women, and to test the reliability and validity and explore its predictive value. Methods With literature review and Delphi expert consultation method, the draft of early warning assessment scale for high-risk pregnant women was formed. The reliability and validity of the scale were tested in 150 high-risk hospitalized pregnant women, and the predictive efficacy of the scale for the occurrence of serious/critical disease in high-risk pregnant women was analyzed. Results The early warning assessment scale for high-risk pregnant women consisted of 4 dimensions and 23 items. The intra-class correlation coefficient (ICC) was 0.905, and the 95% confidence interval (CI) ranged from 0.855 to 0.945. The average content validity ratio (CVR) was 0.96 and the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and Jordan index were 92.5%, 68.2%, 51.4%, 97.4%, 18.00, 0.53 and 0.61 respectively, and AUROC of the assessment scale was 0.803. AUROC of predicting severe/critical disease was 0.719 and the sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were 85.7%, 58.1%, 10.23, and 0.64 respectively. Conclusion The early warning assessment scale for high-risk pregnant women constructed in this study has good reliability and validity. It can predict the occurrence of acute obstetric events and critical obstetric diseases. The scale can be used as a tool to evaluate the condition of high-risk pregnant women and provide basis for early warning and evaluation of high-risk pregnant women.

Key words: high-risk pregnant women, early warning, assessment, reliability, validity

中图分类号: 

  • R473.71
[1] WHO Media Centre. Maternal Mortality[EB/OL].(2016-11-20)[2020-06-30].http://www.who.int/mediacentre/factsheets/fs348/zh/.
[2] 吴茜,龚美芳,孙晓,等.住院患者护理高危风险预警预控体系构建与运作[J].护理学报,2015,22(1):16-20.DOI:10.16460/j.issn1008-9969.2015.01.016.
[3] 黄彦清,叶桂香.护理预警在妇产科门诊分诊中的应用[J].护理学报,2016,23(12):27-29.DOI:10.16460/j.issn1008-9969.2016.12.027.
[4] Arora KS, Shields LE, Grobman WA,et al.Triggers,Bundles,Protocols and Checklists-what Every Maternal Care Provider Needs to Know[J].AM J Obstet Gynecol,2016,214(4):444-451.DOI:10.1016/j.ajog.2015.10.011.
[5] American College of Obstetricians and Gynecologists Committee on Patient Safety and Quality Improvement.Committee Opinion No.590:Preparing for Clinical Emergencies in Obstetrics and Gynecology[J]. Obstet Gynecol, 2014,123(3):722-725.DOI:10.1097/01.AOG.0000444442.04111.c6.
[6] Plante L A. Practice Bulletin No.170:Critical Care in Pregnancy[J].Obstet Gynecol,2016,128(4):e147-e154.DOI:10.1097/AOG.0000000000001710.
[7] Committee on Practice Bulletins-obstetrics.Practice Bulletin No.183:Postpartum Hemorrhage[J].Obstet Gynecol,2017,130(4):e168-e186.DOI:10.1097/AOG.0000000000002351.
[8] American College of Obstetricians and Gynecologists.ACOG Practice Bulletin No.202:Gestational Hypertension and Preeclampsia[J].Obstet Gynecol,2019,133(1):e1-e25.DOI:10.1097/AOG.0000000000003018.
[9] American Diabetes Association.Management of Diabetes in Pregnancy:Standards of Medical Care in Diabetes-2020[J].Diabetes Care, 2020, 43(Suppl 1):S183-S192.DOI:10.2337/dc20-S014.
[10] Regitz-zagrosek V, Roos-hesselink JW,Bauersachs J,et al.2018 ESC Guidelines for the Management of Cardiovascular Diseases During Pregnancy[J]. Eur Heart J, 2018,39(34):3165-3241.DOI:10.1093/eurheartj/ehy340.
[11] Society for Maternal-fetal Medicine(SMFM). Amniotic Fluid Embolism:Diagnosis and Management[J].Am J Obstet Gynecol,2016,215(2):B16-24.DOI:10.1016/j.ajog.2016.03.012.
[12] Bowyer L, Robinson HL, Barrett H,et al.SOMANZ Guidelines for the Investigation and Management Sepsis in Pregnancy[J].Aust NZ J Obstet Gyn,2017,57(5):540-551.DOI:10.1111/ajo.12646.
[13] American College of Obstetricians and Gynecologists.ACOG Practice Bulletin No.196: Thromboembolism in Pregnancy:Correction[J]. Obstet Gynecol,2018,132(4):1068.DOI:10.1097/AOG.0000000000002923.
[14] 韩微,樊雅静,黄翠琴,等.改良早期预警评分在危重孕产妇护理中的应用效果评价[J].上海护理,2016,16(2):9-12.DOI:1009-8399(2016)02-0009-04.
[15] Singh S, Mcglennan A,England A,et al.A Validation Study of the CEMACH Recommended Modified Early Obstetric Warning System(MEOWS)[J].Anaesthesia,2012,67(1):12-18.DOI:10.1111/j.1365-2044.2011.06896.x.
[16] Paternina-caicedo A, Miranda J, Bourjeily G, et al.Performance of the Obstetric Early Warning Score in Critically Ill Patients for the Prediction of Maternal Death[J].Am J Obstet Gynecol,2017,216(1):58.e1-58.e8.DOI:10.1016/j.ajog.2016.09.103.
[17] Hedriana HL, Wiesner S,Downs BG,et al.Baseline Assessment of a Hospital-specific Early Warning Trigger System for Reducing Maternal Morbidity[J].Int J Gynaecol Obstet,2015,132(3):337-341.DOI:10.1016/j.ijgo.2015.07.036.
[18] 岳丽红,郭锦丽.妊娠晚期潜在危重孕妇预警指标体系的构建[J].中国临床护理,2018,10(6):31-35.DOI:10.3969/j.issn.1674-3768.2018.06.007.
[19] 厉跃红,郭娜菲,庄薇.国外产科早期预警系统发展现状及对我国的启示[J].中华围产医学杂志,2017,20(12):855-858.DOI:10.3760/cma.j.issn.1007-9408.2017.12.003.
[20] 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,2010:158-265.
[21] Mhyre JM, D’Oria R,Hameed AB,et al.The Maternal Early Warning Criteria:A Proposal from the National Partnership for Maternal Safety[J].J Obst Gyn Neo,2014, 43(6):771-779.DOI:10.1097/AOG.0000000000000480.
[22] Ryan HM, Jones MA,Payne BA,et al.Validating the Performance of the Modified Early Obstetric Warning System Multivariable Model to Predict Maternal Intensive Care Unit Admission[J].J Obstet Gynaecol Can,2017,39(9):728-733.DOI:10.1016/j.jogc.2017.01.028.
[23] 张灵芳,赵明利,张雪葳,等.待产孕妇风险预警评估工具的构建及评试[J].中国生育健康杂志,2019,30(3):211-214.DOI:10.3969/j.issn.1671-878X.2019.03.003.
[24] 黄晓波,韦琴,文燕,等.早产儿早期预警评分表的编制及信效度检验[J].护理学报,2018,24(15):1-5. DOI:10.16460/j.issn1008-9969.2018.15.001.
[25] 曾欣. 改良早期预警评分在危重孕产妇护理中的应用效果[J].医疗装备,2018,31(12):176-177.DOI:10.3969/j.issn.1002-2376.2018.12.128.
[26] 赵小军. 改良早期预警评分在高危孕产妇护理中的应用价值研究[J].基层医学论坛,2019, 23(15):2111-2112.DOI:10.19435/j.1672-1721.2019.15.023.
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