肺移植患者术后早期离床安全评估量表的编制及信效度检验

doi:10.3761/j.issn.0254-1769.2025.10.013

摘要/Abstract

摘要：

目的研制肺移植患者术后早期离床安全评估量表并检验其信效度。方法于2022年9月—2023年4月，采用文献分析法、专家会议法、德尔菲函询法构建量表初稿。于2023年6月—2024年5月，采用方便抽样法，选取江苏省某三级甲等综合医院肺移植中心收治的135例患者进行调查，应用项目分析、信度分析及效度分析对条目进行调整，形成最终版量表。结果肺移植患者术后早期离床安全评估量表共包括意识水平、生命体征、疾病相关、活动能力和营养状态5个维度、18个条目。量表的评定者间信度为0.985；量表水平的内容效度为0.853；总的分半信度为0.716；预测患者72 h内发生离床不良事件的受试者操作特征曲线下面积为0.845，95%CI为0.767~0.917（P<0.001），最佳临界值为18.5，对应的灵敏度为0.735，特异度为0.782。结论构建的肺移植患者术后早期离床安全评估量表信效度良好，可作为临床评估肺移植患者术后早期离床活动安全性的测量工具。

关键词: 肺移植, 早期离床, 安全评估, 量表构建, 护理

Abstract:

Objective To develop and validate a safety assessment scale for early mobilization in lung transplant patients after surgery. Methods From September 2022 to April 2023，a preliminary scale was constructed using literature analysis，expert meetings，and the Delphi method. From June 2023 to May 2024，a convenience sampling was used to select 135 patients admitted to the lung transplant center of a tertiary general hospital in Jiangsu Province. Item analysis，reliability analysis，and validity analysis were applied to adjust the items，forming the final scale. Results The post-operative early mobilization safety assessment scale for lung transplant patients includes 5 dimensions（consciousness level，vital signs，disease-related factors，mobility，and nutritional status） and 18 items. The inter-rater reliability of the scale is 0.985；the overall content validity index is 0.853；the split-half reliability is 0.716. The area under the receiver operating characteristic curve for predicting adverse events within 72 hours of mobilization is 0.845，with a 95% confidence interval of 0.767 to 0.917（P<0.001）. The optimal cutoff value is 18.5，with a sensitivity of 0.735 and a specificity of 0.782. Conclusion The developed safety assessment scale for early mobilization in lung transplant patients after surgery demonstrates good reliability and validity，and it can serve as a clinical tool to assess the safety of early mobilization activities in these patients.

Key words: Lung Transplantation, Early Mobilization, Safety Assessment, Scale Development, Nursing Care

郑晓敏, 蔡英华, 周海琴, 万霞. 肺移植患者术后早期离床安全评估量表的编制及信效度检验[J]. 中华护理杂志, 2025, 60(10): 1237-1243.

ZHENG Xiaomin, CAI Yinghua, ZHOU Haiqin, WAN Xia. Development and validation of a safety assessment scale for postoperative early mobilization for lung transplant patients[J]. Chinese Journal of Nursing, 2025, 60(10): 1237-1243.

图/表 1

参考文献 21

[1]	Perch M, Hayes D Jr, Cherikh WS, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation:thirty-ninth adult lung transplantation report-2022;focus on lung transplant recipients with chronic obstructive pulmonary disease[J]. J Heart Lung Transplant, 2022, 41(10):1335-1347.
[2]	Ulvestad M, Durheim MT, Kongerud JS, et al. Cardiorespiratory fitness and physical activity following lung transplantation:a national cohort study[J]. Respiration, 2020, 99(4):316-324. DOI PMID
[3]	郑晓敏, 蔡英华, 周海琴, 等. 快速康复外科理念在肺移植患者围手术期中应用的范围综述[J]. 中华护理杂志, 2022, 57(16):2018-2024.
	Zheng XM, Cai YH, Zhou HQ, et al. The application of enhan-ced recovery after surgery in the perioperative period of lung transplantation:a scoping review[J]. Chin J Nurs, 2022, 57(16):2018-2024.
[4]	Engelman DT, Ben AW, Williams JB, et al. Guidelines for pe-rioperative care in cardiacsurgery:enhanced recovery after sur-gery society recommendations[J]. JAMA Surg, 2019, 154(8):755-766. DOI PMID
[5]	中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021版)[J]. 中国实用外科杂志, 2021, 41(9):961-992.
	Chinese Society of Surgery of Chinese Medical Association, Chinese Society of Anesthesiology of Chinese Medical Associa-tion. Clinical practice guidelines for ERAS in China(2021)[J]. Chin J Pract Surg, 2021, 41(9):961-992.
[6]	郑晓敏, 蔡英华, 周海琴, 等. 肺移植病人术后早期离床活动现状及影响因素分析[J]. 护理研究, 2023, 37(4):602-607.
	Zheng XM, Cai YH, Zhou HQ, et al. Status quo and influencing factors of early out of bed activities in patients with lung transplantation[J]. Chin J Nurs Res, 2023, 37(4):602-607.
[7]	梁江淑渊, 曾妃, 顾培培, 等. 肺移植术后患者匹配式运动训练方案的构建及应用[J]. 中华护理杂志, 2023, 58(8):901-906. DOI
	Liang JSY, Zeng F, Gu PP, et al. Construction and application of a matching exercise training program for patients after lung transplantation[J]. Chin J Nurs, 2023, 58(8):901-906. DOI
[8]	蔡英华, 姚勇. 肺移植临床护理实践[M]. 南京: 东南大学出版社, 2021.
	Cai YH, Yao Y. Clinical nursing practice of lung transplanta-tion[M]. Nanjing: Southeast University Press, 2021.
[9]	Kasotakis G, Schmidt U, Perry D, et al. The surgical intensive care unit optimal mobility score predicts mortality and length of stay[J]. Crit Care Med, 2012, 40(4):1122-1128. DOI PMID
[10]	Hodgson C, Needham D, Haines K, et al. Feasibility and inter-rater reliability of the ICU Mobility Scale[J]. Heart Lung, 2014, 43(1):19-24. DOI PMID
[11]	Perme C, Nawa RK, Winkelman C, et al. A tool to assess mo-bility status in critically ill patients:the Perme Intensive Care Unit Mobility Score[J]. Methodist Debakey Cardiovasc J, 2014, 10(1):41-49.
[12]	Playford D. The international classification of functioning,disa-bility,and health[M]. Oxford: Oxford University Press, 2015:3-7.
[13]	Zhu S, Wang Z, Liang Q, et al. Chinese guidelines for the re-habilitation treatment of knee osteoarthritis:an CSPMR evide-nce-based practice guideline[J]. J Evid Based Med, 2023, 16(3):376-393.
[14]	延芝丽, 杨支兰, 赵慧敏, 等. 老年人内在能力评估量表的编制及信效度检验[J]. 中华护理杂志, 2024, 59(15):1852-1859. DOI
	Yan ZL, Yang ZL, Zhao HM, et al. Development and reliability and validity test of the intrinsic capacity assessment scale for the older people[J]. Chin J Nurs, 2024, 59(15):1852-1859. DOI
[15]	Leard LE, Holm AM, Valapour M, et al. Consensus document for the selection of lung transplant candidates:an update from the International Society for Heart and Lung Transplantation[J]. J Heart Lung Transplant, 2021, 40(11):1349-1379.
[16]	周幺玲, 夏瑾燕, 刘雪, 等. 老老照护能力评估量表的研制和信效度检验[J]. 中华护理杂志, 2024, 59(10):1180-1186. DOI
	Zhou YL, Xia JY, Liu X, et al. Development of an assessment scale of the aged care aptitude for the aged and test of its reliability and validity[J]. Chin J Nurs, 2024, 59(10):1180-1186. DOI
[17]	谭铮可可, 杨丽, 唐雯桢, 等. 腹部大手术患者首次下床跌倒恐惧的潜在剖面分析及护理启示[J]. 中华护理杂志, 2024, 59(20):2479-2486. DOI
	Tan ZKK, Yang L, Tang WZ, et al. Fear of falling in the initial ambulation day among patients undergoing major abdominal surgery:the latent profile analysis and nursing enlightenment[J]. Chin J Nurs, 2024, 59(20):2479-2486.
[18]	兰美娟, 曾妃, 梁江淑渊. 双肺移植患者肺康复方案的构建及应用[J]. 中华护理杂志, 2022, 57(6):659-665. DOI
	Lan MJ, Zeng F, Liang JSY. Construction and application of apulmonary rehabilitation program in patients with double lung transplantation[J]. Chin J Nurs, 2022, 57(6):659-665.
[19]	车靖岳, 朱兆芳. 主客观组合赋权法在妇幼保健机构绩效评价中的应用[J]. 中国卫生经济, 2022, 41(11):74-77.
	Che JY, Zhu ZF. Performance evaluation of applying maternal and child healthinstitutions based on objective and subjective synthetic approach[J]. Chin H Econ, 2022, 41(11):74-77.
[20]	李峥, 刘宇. 护理学研究方法[M]. 2版. 北京: 人民卫生出版社, 2018.
	Li Z, Liu Y. Nursing research methods[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018.
[21]	丁思妍, 周海琴, 史晓芬, 等. 肺移植营养不良患者多学科营养管理方案的构建与应用[J]. 护理学杂志, 2021, 36(16):1-5.
	Ding SY, Zhou HQ, Shi XF, et al. Construction and applica-tion of multidisciplinary nutrition management scheme for malnourished patients undergoing lung transplantation[J]. J Nurs Sci, 2021, 36(16):1-5.