摘要
目的 探讨老年肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)重症预警指标及护理对策.方法 纳入2018年1月至2022年12月空军军医大学第二附属医院传染科收治的146例临床和实验室确诊的老年HFRS患者.根据疾病严重程度,将其分为轻症组(轻型、中型)(n=64)和重症组(重型、危重型)(n=82).收集患者性别、年龄、基础疾病、症状和体征等临床资料.用多因素Logistic回归分析老年HFRS重症预警指标,并提出相应护理对策.结果 重症组入院时发热、纳差、胸闷/气短、恶心/呕吐、腹痛/腹泻、尿量减少、皮肤黏膜出血、球结膜水肿、肾区叩击痛及多期重叠发生率均高于轻症组(P均<0.05).多因素Logistic回归分析显示,出现胸闷/气短、恶心/呕吐、尿量减少、皮肤黏膜出血和多期重叠是老年HFRS重症预警指标.结论 医护人员在临床实践中需重视老年HFRS重症的预警指标,疾病早期出现胸闷/气短、恶心/呕吐、尿量减少、皮肤黏膜出血及多期重叠的患者,病情往往向重症进展,需早期干预并采取针对性的个体化护理措施.
Abstract
Objective To investigate the early warning indicators of severity and corresponding nursing interventions for elderly patients suffering from hemorrhagic fever with renal syndrome (HFRS). Methods This study encompassed 146 clinically and laboratory-confirmed elderly patients (aged 60 years or above) diagnosed with HFRS and admitted to the Infectious Department of the Second Affiliated Hospital of Air Force Military Medical University between January 2018 and December 2022. The patients were categorized into 2 groups based on the severity of their condition:the mild group (comprising of mild and moderate cases) (n=64) and the severe group (including severe and critical cases) (n=82). Data on various clinical parameters such as gender,age,comorbidities,symptoms,and signs were collected. Multivariate Logistic regression analysis was employed to identify the early warning indicators of severity in these elderly patients,and accordingly,appropriate nursing interventions were proposed. Results The positive rates of symptoms such as fever,anorexia,chest tightness/shortness of breath,nausea/vomiting,abdominal pain/diarrhea,decreased urine volume,skin and mucosal bleeding,chemosis,renal area tenderness,and multi-stage overlap were significantly higher in the severe group compared to the mild group (P<0.05). Multivariate Logistic regression analysis revealed that chest tightness/shortness of breath,nausea/vomiting,decreased urine volume,skin and mucosal bleeding,and the presence of multiple overlapping symptoms served as significant severe warning indicators for elderly patients with HFRS (P<0.05). Conclusions In clinical practice,medical personnel should be vigilant about the severe warning indicators specific to elderly patients with HFRS. For those experiencing early symptoms of chest tightness/shortness of breath,nausea/vomiting,decreased urine volume,skin and mucosal bleeding,and multiple overlapping symptoms,there is a higher risk of progression to severe disease. Therefore,prompt early warning systems and targeted individualized nursing interventions are imperative.
维普
万方数据