Abstract:

Objective To develop a rapid screening and graded early warning tool for the risk of postoperative pulmonary complications in ICU patients and to conduct a preliminary evaluation of its feasibility. Methods An initial pool of assessment indicators was generated through a systematic literature review and group discussions from June to August 2025. The Delphi expert consultation method was then used to construct the ICU postoperative pulmonary complication risk screening and graded early warning tool from September to November 2025，which consists of 2 modules, namely an assessment and screening indicators module and a risk grading module. From December 1 to 20，2025， adult patients transferred to the ICU following surgery and ICU nurses from a tertiary general hospital in Beijing were selected as study subjects. A descriptive study design was adopted to analyze the feasibility of this tool in terms of its implementation in the ICU and nurses’acceptability. Results A total of 2 rounds of expert consultation were completed，with a 100% valid questionnaire recovery rate in both rounds. The expert authority coefficients were 0.925 and 0.900， respectively. After the 2 rounds of consultation， the Kendall’s coefficient of concordance for the indicators was 0.124（P=0.040）. The final tool consisted of Module 1，a screening and assessment form, which included 3 first-level domains（individual factors，treatment factors，and physiological function），9 second-level indicators， and 33 graded scoring items； Module 2， the risk level classification, in which the risk level was determined using a dual-criterion method combining total score and the number of high-score items. For the feasibility analysis, 30 postoperative patients transferred to the ICU and 8 nurses were included. A total of 753 assessments were planned， of which 738 were actually completed， yielding a completion rate of 98.01%. The mean time required for the first assessment was（4.80±0.52） minutes. Among all assessments， 6 patients were identified as being at persistently high risk，and 5 of them subsequently developed postoperative pulmonary complications，accounting for 83.33% of the persistently high-risk patients. The results of the nurse acceptability evaluation showed that the tool received high scores in terms of ease of use， clarity of scoring criteria, reasonableness of time burden, clinical relevance， and willingness for continued use， all>4.75 points. Conclusion The ICU postoperative pulmonary complication risk screening and graded early warning tool developed in this study has a clear structure and well defined procedures. Preliminary application suggests that it has good operability and high acceptability among nurses.

Key words: Intensive Care Unit, Postoperative Pulmonary Complications, Risk Assessment, Delphi Technique, Nursing Care

摘要：

目的 构建适用于ICU患者的术后肺部并发症风险筛查及分级预警工具，并初步评价其可行性。方法 2025年6—8月通过系统文献回顾和小组讨论，初步形成评估指标条目池。2025年9—11月采用德尔菲法进行函询，构建包含筛查评估、风险等级评定2个模块的工具。2025年12月1—20日选取北京市某三级甲等医院ICU收治的手术后转入的成人患者和ICU护士作为研究对象，采用描述性研究设计，对该工具在ICU中的实施情况及护士可接受性进行可行性分析。结果 共完成2轮专家函询，有效问卷回收率均为100%，专家权威系数分别为0.925和0.900，第2轮函询后指标的肯德尔和谐系数为0.124（P=0.040）。最终构建的工具包含：模块一筛查评估，有个体因素、治疗因素、生理功能3个一级指标、9个二级指标及33个等级赋分条目；模块二为风险等级评定，采用总分结合高分项数量的双重判定方式进行评定。可行性分析共纳入术后转入ICU患者30例，护士8名，计划评估753次，实际完成738次，评估完成率为98.01%；首次评估耗时为（4.80±0.52）min。所有评估中，持续高危患者6例，其中后续发生术后肺部并发症5例，占持续高危患者的83.33%。护士可接受性评价结果显示，该工具在操作简便性、评分标准理解清晰度、时间负担合理性、临床相关性及继续使用意愿等方面得分均较高，均>4.75分。结论 构建的ICU患者术后肺部并发症风险筛查及分级预警工具结构清晰、流程明确，初步应用表明其具有良好的可操作性与可接受性。

关键词: 重症监护室, 术后肺部并发症, 风险筛查, 德尔菲技术, 护理