缺血性脑卒中患者多维度护理级别与医嘱护理级别一致性的比较研究

doi:10.3761/j.issn.0254-1769.2026.15.001

摘要/Abstract

摘要：

目的构建并验证基于多维度量化评估的缺血性脑卒中患者护理级别判定规则，分析其与临床医嘱护理级别的一致性及判定特征，为护理级别动态评估提供量化参考。方法通过文献回顾、专家小组讨论和专家函询形成多维度护理级别判定规则。采用回顾性研究设计，选取2024年10月—2025年6月某三级甲等医院神经内科458例缺血性脑卒中患者作为调查对象，以首次医嘱护理级别变更时点为研究情境，提取6项评估指标生成多维度护理级别。以医嘱护理级别为参照，采用一致率、线性加权Kappa系数、组间比较及分类与决策树模型分析判定效果。结果最终纳入447例患者，多维度护理级别与医嘱护理级别一致360例，一致率为80.54%，线性加权Kappa系数为0.674；特级、一级、二级护理正确识别率分别为100%、94.12%、68.20%。不一致病例主要为医嘱二级护理被判定为一级护理，两组各评估指标比较差异均有统计学意义。分类与决策树模型显示，美国国立卫生研究院脑卒中量表评分为首层分裂变量，Barthel指数、改良早期预警评分和患者健康问卷抑郁量表评分纳入护理级别判定。结论多维度护理级别与医嘱护理级别具有中等一致性，可为护士开展缺血性脑卒中患者护理级别动态评估提供量化参考。

关键词: 缺血性脑卒中, 分级护理, 护理评估, 决策树

Abstract:

Objective To develop multidimensional nursing level determination rules for patients with ischemic stroke，analyze their consistency with physician-ordered nursing levels，and provide a quantitative reference for nurses to participate in dynamic nursing level assessment. Methods The multidimensional nursing level determination rules were developed through literature review，expert group discussion and expert consultation. A retrospective study was conducted among 458 patients with ischemic stroke in the neurology department of a tertiary hospital from October 2024 to June 2025. Taking the first change in physician-ordered nursing level as the study context，6 assessment indicators were extracted to generate multidimensional nursing levels. Using physician-ordered nursing levels as the reference，the consistency rate，linear weighted Kappa coefficient，between-group comparison and classification and regression tree were used to analyze the determination effect. Results A total of 447 patients were ultimately enrolled in this study. The multidimensional nursing levels were consistent with physician-ordered nursing levels in 360 cases，with a consistency rate of 80.54% and a linear weighted Kappa coefficient of 0.674. The correct recognition rates for special，first-level and second-level nursing were 100%，94.12% and 68.20%，respectively. Inconsistent cases were mainly physician-ordered second-level nursing classified as first-level nursing. Differences in all assessment indicators between the 2 groups were statistically significant. Classification and regression tree analysis showed that the National Institutes of Health Stroke Scale score was the first splitting variable，while the Barthel Index，Modified Early Warning Score and Patient Health Questionnaire-9 score participated in the determination of nursing level. Conclusion Multidimensional nursing levels have moderate consistency with physician-ordered nursing levels and may provide a quantitative reference for nurses to conduct dynamic nursing level assessment in patients with ischemic stroke.

Key words: Ischemic Stroke, Graded Nursing Care, Nursing Assessment, Decision Trees

王芝怡, 李博, 魏玲玲, 郑健花, 翟蒙翠, 屈辉, 俞燕娟, 卢明. 缺血性脑卒中患者多维度护理级别与医嘱护理级别一致性的比较研究[J]. 中华护理杂志, 2026, 61(15): 2021-2027.

WANG Zhiyi, LI Bo, WEI Lingling, ZHENG Jianhua, ZHAI Mengcui, QU Hui, YU Yanjuan, LU Ming. Comparison study on the consistency between multidimensional nursing levels and physician-ordered nursing levels in patients with ischemic stroke[J]. Chinese Journal of Nursing, 2026, 61(15): 2021-2027.

图/表 4

表1 缺血性脑卒中患者多维度护理级别判定规则

Table 1 Multidimensional nursing level determination rules for patients with ischemic stroke

图1 缺血性脑卒中患者多维度护理级别的决策树模型注：NIHSS为美国国立卫生研究院卒中量表；BI为Barthel指数；MEWS为改良早期预警评分；PHQ-9为患者健康问卷抑郁量表。

Figure 1 Decision tree model of multidimensional nursing levels in patients with ischemic stroke

表2 缺血性脑卒中患者多维度护理级别的决策树判定路径

Table 2 Decision tree determination paths of multidimensional nursing levels in patients with ischemic stroke

表3 一致组与不一致组各评估指标得分的比较[分，M（P25，P75）]

Table 3 Comparison of assessment indicator scores between the consistent and inconsistent groups[score，M（P25，P75）]

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