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Article(id=1322931412298499067, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322931411006665649, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.13.018, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1744128000000, receivedDateStr=2025-04-09, revisedDate=1780243200000, revisedDateStr=2026-06-01, acceptedDate=null, acceptedDateStr=null, onlineDate=1793341027568, onlineDateStr=2026-10-30, pubDate=1783612800000, pubDateStr=2026-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793341027568, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793341027568, creator=13701087609, updateTime=1793341027568, updator=13701087609, issue=Issue{id=1322931411006665649, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='13', pageStart='2193', pageEnd='2384', issueExtLink='null', onlineDate='null', pubDate='1783612800000', pubDateStr='2026-07-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793341027261, creator='13701087609', updateTime=1793343114456, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940165425082661, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322931411006665649, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940165425082662, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322931411006665649, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2320, endPage=2326, ext={EN=ArticleExt(id=1322931412730512381, articleId=1322931412298499067, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Analysis of influencing factors and construction of a prediction model for acute skin failure in ICU patients, columnId=1220689488284668633, journalTitle=Chinese Nursing Research, columnName=Comprehensive Study, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the risk factors for acute skin failure patients in intensive care unit(ICU) and to construct a predictive model.

Methods

A total of 377 ICU patients from a tertiary grade A hospital between January 2021 and December 2023 were selected as the study subjects.Univariate analysis and Logistic regression analysis were used to identify the influencing factors for acute skin failure patients in ICU,based on which a risk prediction model was constructed and subsequently validated.

Results

Among the 377 patients,89 developed acute skin failure,yielding an incidence rate of 23.6%.The Logistic regression analysis identified age,sepsis,peripheral perfusion index(PPI) use,albumin level,and vasopressor administration as significant influencing factors for acute skin failure.The area under the receiver operating characteristic curve for the Nomogram model established based on these factors was 0.890,with a sensitivity of 89.2% and a specificity of 78.2%.The Hosmer-Lemeshow test indicated a good model fit(χ²=6.462,P=0.290).

Conclusions

The constructed risk prediction model for acute skin failure patients in ICU demonstrates excellent predictive performance.The model could serve as an effective and practical tool for identifying high-risk patients.

, authors=Quanyan YE1, Guoqing LI1, Yuan XUE1, Xiaoyu ZHAO1, Jinli GUO2, authorsList=Quanyan YE, Guoqing LI, Yuan XUE, Xiaoyu ZHAO, Jinli GUO, authorCompany=null, correspAuthors=Jinli GUO, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322931419806302214, articleId=1322931412298499067, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=ICU病人急性皮肤衰竭影响因素及预测模型构建, columnId=1220689488938980091, journalTitle=护理研究, columnName=综合研究, runingTitle=null, highlight=null, articleAbstract=
目的

探讨重症监护室（ICU）病人急性皮肤衰竭的危险因素，并构建预测模型。

方法

选取2021年1月—2023 年12月某三级甲等医院的377例ICU病人为研究对象，采用单因素分析和Logistic回归分析筛选ICU病人发生急性皮肤衰竭的影响因素，构建 ICU病人急性皮肤衰竭风险预测模型，并对模型进行验证。

结果

377例病人中，89例发生急性皮肤衰竭，发生率为23.6%；Logistic回归分析结果显示，年龄、脓毒症、外周灌注指数（PPI）、血清白蛋白和使用血管活性药物是急性皮肤衰竭的影响因素。基于以上因素建立的列线图模型受试者工作特征曲线下面积为0.890，灵敏度为89.2%，特异度78.2%。H-L检验显示，χ2=6.462，P=0.290。

结论

构建的ICU病人急性皮肤衰竭风险预测模型具有良好的预测效能，可作为临床早期识别高危人群的有效工具。

, authors=叶泉滟1, 李国庆1, 薛媛1, 赵晓雨1, 郭锦丽2, *, *, authorsList=叶泉滟, 李国庆, 薛媛, 赵晓雨, 郭锦丽, authorCompany=null, correspAuthors=郭锦丽, authorNote=

叶泉滟，护士，硕士研究生在读

, correspAuthorsNote=
郭锦丽，E-mail：
GUO Jinli, E-mail:
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Cox J, Smith D, journalName=Advances in Skin & Wound Care, refType=null, unstructuredReference=Delmore B,Cox J,Smith D,et al.Acute skin failure in the critical care patient[J].Advances in Skin & Wound Care,2020,33(4):192-201., articleTitle=Acute skin failure in the critical care patient, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322931420649357320, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931412298499067, xref=1, ext=[AuthorCompanyExt(id=1322931420661940233, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931412298499067, companyId=1322931420649357320, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1School of Nursing, Shanxi Medical University, Shanxi 030001 China), AuthorCompanyExt(id=1322931420670328842, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931412298499067, companyId=1322931420649357320, language=CN, 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articleId=1322931412298499067, language=EN, label=Figure 1, caption=Nomogram model for the risk of acute skin failure in ICU patients, figureFileSmall=Uxv2Tsm0ByAbujVAnJYC0g==, figureFileBig=G+UMxkkFVxAAjURArxbgdQ==, tableContent=null), ArticleFig(id=1322931429109268532, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931412298499067, language=CN, label=图1, caption=ICU病人急性皮肤衰竭发生风险的列线图模型, figureFileSmall=Uxv2Tsm0ByAbujVAnJYC0g==, figureFileBig=G+UMxkkFVxAAjURArxbgdQ==, tableContent=null), ArticleFig(id=1322931429285429301, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931412298499067, language=EN, label=Figure 2, caption=ROC curve of the nomogram for predicting acute skin failure in ICU patients, figureFileSmall=FmI+Kg0YDijMIwSD4/wX8g==, figureFileBig=ivJVYWiKaR48f9z0BPf5kA==, tableContent=null), ArticleFig(id=1322931429360926774, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931412298499067, language=CN, label=图2, caption=ICU病人急性皮肤衰竭列线图模型的ROC曲线, figureFileSmall=FmI+Kg0YDijMIwSD4/wX8g==, figureFileBig=ivJVYWiKaR48f9z0BPf5kA==, tableContent=null), ArticleFig(id=1322931429423841335, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931412298499067, language=EN, label=Figure 3, caption=Calibration curve of the nomogram for predicting acute skin failure in ICU patients, figureFileSmall=AJcggSD0f4cUr/ww7L9tlg==, figureFileBig=wjSPeamTkuBinDzDehEl2g==, tableContent=null), ArticleFig(id=1322931429486755896, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931412298499067, language=CN, label=图3, caption=ICU病人急性皮肤衰竭列线图模型的校准曲线, figureFileSmall=AJcggSD0f4cUr/ww7L9tlg==, figureFileBig=wjSPeamTkuBinDzDehEl2g==, tableContent=null), ArticleFig(id=1322931429553864761, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931412298499067, language=EN, label=Table 1, caption=

Univariate analysis of influencing factors of acute skin failure in ICU patients（n=377）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类发生组（n=89）未发生组（n=288）统计值P
性别[例(%)]男68(76.40)188(65.28)χ2=3.3690.066
女21(23.60)100(34.72)
年龄[例(%)]<65岁10(11.24)121(42.01)χ2=27.064<0.001
≥65岁79(88.76)167(57.99)
BMI(kg/m2)23.40(20.80,24.90)22.60(20.80,24.53)Z=-1.1010.271
基础疾病[例(%)]呼吸衰竭38(42.70)139(48.26)χ2=2.8160.832
心力衰竭19(21.35)60(20.83)
肾衰竭10(11.24)30(10.42)
肝功能衰竭5(5.62)21(7.29)
创伤8(8.97)15(5.21)
肿瘤4(4.50)9(3.13)
其他5(5.62)14(4.86)
体温（℃）37.01±1.3836.85±0.98t=0.8350.491
平均动脉压（mmHg）54(52,55)107(68,114)Z=-8.2200.025
收缩压≤90 mmHg[例(%)]是54(60.67)148(51.39)χ2=1.9980.157
否35(39.33)140(48.61)
PPI[例(%)]<1.549(55.06)198(68.75)χ2=5.053<0.001
≥1.540(44.94)90(31.25)
Braden评分[例(%)]<9分22(24.72)91(31.60)χ2=17.610<0.001
9~12分67(75.28)158(54.86)
>12分0(0.00)39(13.54)
APACHE-Ⅱ评分(分)13.70±2.108.21±2.88t=12.419<0.001
SOFA评分[例(%)]<2分20(22.47)75(26.04)χ2=0.2900.590
≥2分69(77.53)213(73.96)
RASS评分[例(%)]>-1~1分21(23.60)60(20.83)χ2=3.0490.218
>-3~-1分25(28.01)60(20.83)
>-5~-3分43(48.39)168(58.34)
GCS评分[例(%)]≤8分62(69.66)127(44.10)Z=-2.1380.133
>8~<12分20(22.47)81(28.12)
≥12分7(7.87)80(27.78)
机械通气≥72 h[例(%)]是29(32.58)24(8.33)χ2=31.118<0.001
否60(67.42)264(91.67)
脓毒症[例(%)]是57(64.04)34(11.80)χ2=98.491<0.001
否32(35.96)254(88.20)
使用血管活性药物[例(%)]是57(64.00)14(4.86)χ2=58.492<0.001
否32(36.00)274(95.14)
使用镇静药物[例(%)]是14(15.73)78(27.10)χ2=4.1550.042
否75(84.27)210(72.90)
血糖（mmol/L）10.02±5.039.31±3.71Z=1.6100.110
血乳酸[例(%)]<4 mmol/L80(89.89)111(38.54)χ2=69.672<0.001
≥4 mmol/L9(10.11)177(61.46)
血清白蛋白[例(%)]<30 g/L48(53.93)58(20.14)χ2=36.763<0.001
≥30 g/L41(46.07)230(79.86)
白细胞计数[例(%)]<10×109/L43(48.31)251(87.15)χ2=57.493<0.001
≥10×109/L46(51.69)37(12.85)
), ArticleFig(id=1322931429801328698, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931412298499067, language=CN, label=表1, caption=

ICU病人急性皮肤衰竭影响因素的单因素分析（n=377）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类发生组（n=89）未发生组（n=288）统计值P
性别[例(%)]男68(76.40)188(65.28)χ2=3.3690.066
女21(23.60)100(34.72)
年龄[例(%)]<65岁10(11.24)121(42.01)χ2=27.064<0.001
≥65岁79(88.76)167(57.99)
BMI(kg/m2)23.40(20.80,24.90)22.60(20.80,24.53)Z=-1.1010.271
基础疾病[例(%)]呼吸衰竭38(42.70)139(48.26)χ2=2.8160.832
心力衰竭19(21.35)60(20.83)
肾衰竭10(11.24)30(10.42)
肝功能衰竭5(5.62)21(7.29)
创伤8(8.97)15(5.21)
肿瘤4(4.50)9(3.13)
其他5(5.62)14(4.86)
体温（℃）37.01±1.3836.85±0.98t=0.8350.491
平均动脉压（mmHg）54(52,55)107(68,114)Z=-8.2200.025
收缩压≤90 mmHg[例(%)]是54(60.67)148(51.39)χ2=1.9980.157
否35(39.33)140(48.61)
PPI[例(%)]<1.549(55.06)198(68.75)χ2=5.053<0.001
≥1.540(44.94)90(31.25)
Braden评分[例(%)]<9分22(24.72)91(31.60)χ2=17.610<0.001
9~12分67(75.28)158(54.86)
>12分0(0.00)39(13.54)
APACHE-Ⅱ评分(分)13.70±2.108.21±2.88t=12.419<0.001
SOFA评分[例(%)]<2分20(22.47)75(26.04)χ2=0.2900.590
≥2分69(77.53)213(73.96)
RASS评分[例(%)]>-1~1分21(23.60)60(20.83)χ2=3.0490.218
>-3~-1分25(28.01)60(20.83)
>-5~-3分43(48.39)168(58.34)
GCS评分[例(%)]≤8分62(69.66)127(44.10)Z=-2.1380.133
>8~<12分20(22.47)81(28.12)
≥12分7(7.87)80(27.78)
机械通气≥72 h[例(%)]是29(32.58)24(8.33)χ2=31.118<0.001
否60(67.42)264(91.67)
脓毒症[例(%)]是57(64.04)34(11.80)χ2=98.491<0.001
否32(35.96)254(88.20)
使用血管活性药物[例(%)]是57(64.00)14(4.86)χ2=58.492<0.001
否32(36.00)274(95.14)
使用镇静药物[例(%)]是14(15.73)78(27.10)χ2=4.1550.042
否75(84.27)210(72.90)
血糖（mmol/L）10.02±5.039.31±3.71Z=1.6100.110
血乳酸[例(%)]<4 mmol/L80(89.89)111(38.54)χ2=69.672<0.001
≥4 mmol/L9(10.11)177(61.46)
血清白蛋白[例(%)]<30 g/L48(53.93)58(20.14)χ2=36.763<0.001
≥30 g/L41(46.07)230(79.86)
白细胞计数[例(%)]<10×109/L43(48.31)251(87.15)χ2=57.493<0.001
≥10×109/L46(51.69)37(12.85)
), ArticleFig(id=1322931429889409083, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931412298499067, language=EN, label=Table 2, caption=

Independent variable assignment method

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变量赋值
年龄<65岁=0，≥65岁=1
平均动脉压原值输入
PPI<1.5=0，≥1.5=1
Braden评分<9分=1，9~12分=2，>12分=3
APACHEⅡ评分原值输入
机械通气≥72h否=0，是=1
脓毒症否=0，是=1
使用血管活性药物否=0，是=1
血乳酸<4 mmol/L=0，≥4 mmol/L=1
血清白蛋白<30 g/L=0，≥30 g/L=1
白细胞计数<10×109/L=0，≥10×109/L=1
使用镇静药物否=0，是=1
), ArticleFig(id=1322931429977489468, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931412298499067, language=CN, label=表2, caption=

自变量赋值方式

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值
年龄<65岁=0，≥65岁=1
平均动脉压原值输入
PPI<1.5=0，≥1.5=1
Braden评分<9分=1，9~12分=2，>12分=3
APACHEⅡ评分原值输入
机械通气≥72h否=0，是=1
脓毒症否=0，是=1
使用血管活性药物否=0，是=1
血乳酸<4 mmol/L=0，≥4 mmol/L=1
血清白蛋白<30 g/L=0，≥30 g/L=1
白细胞计数<10×109/L=0，≥10×109/L=1
使用镇静药物否=0，是=1
), ArticleFig(id=1322931430057181245, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931412298499067, language=EN, label=Table 3, caption=

Multivariate analysis of influencing factors of acute skin failure in ICU patients

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变量回归系数标准误Wald χ2值POR值95%置信区间
下限上限
常量-8.3261.69124.256<0.001
年龄0.9080.3576.4790.0102.4801.2445.062
脓毒症1.7630.8974.0250.0455.8311.04232.642
使用血管活性药物1.5540.7144.7420.0294.7311.16819.165
PPI-0.9360.4584.1710.0410.3920.1600.963
血清白蛋白-1.6160.6995.3350.0210.1990.0500.783
), ArticleFig(id=1322931430124290110, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931412298499067, language=CN, label=表3, caption=

ICU病人急性皮肤衰竭影响因素的多因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量回归系数标准误Wald χ2值POR值95%置信区间
下限上限
常量-8.3261.69124.256<0.001
年龄0.9080.3576.4790.0102.4801.2445.062
脓毒症1.7630.8974.0250.0455.8311.04232.642
使用血管活性药物1.5540.7144.7420.0294.7311.16819.165
PPI-0.9360.4584.1710.0410.3920.1600.963
血清白蛋白-1.6160.6995.3350.0210.1990.0500.783
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ICU病人急性皮肤衰竭影响因素及预测模型构建
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叶泉滟 1 , 李国庆 1 , 薛媛 1 , 赵晓雨 1 , 郭锦丽 2, *, *
护理研究 | 综合研究 2026,40(13): 2320-2326
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护理研究 |综合研究 2026 , 40 (13) : 2320 -2326
ICU病人急性皮肤衰竭影响因素及预测模型构建
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叶泉滟1, 李国庆1, 薛媛1, 赵晓雨1, 郭锦丽2, *, *
作者信息
  • 1山西医科大学护理学院，山西 030001
  • 2山西医科大学第二医院
通讯作者:
郭锦丽，E-mail：
GUO Jinli, E-mail:
作者简介:

叶泉滟，护士，硕士研究生在读

Analysis of influencing factors and construction of a prediction model for acute skin failure in ICU patients
Quanyan YE1, Guoqing LI1, Yuan XUE1, Xiaoyu ZHAO1, Jinli GUO2
Affiliations
  • 1School of Nursing, Shanxi Medical University, Shanxi 030001 China
  • 2The Second Hospital of Shanxi Medical University
出版时间: 2026-07-10 doi: 10.12102/j.issn.1009-6493.2026.13.018
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摘要
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目的

探讨重症监护室（ICU）病人急性皮肤衰竭的危险因素，并构建预测模型。

方法

选取2021年1月—2023 年12月某三级甲等医院的377例ICU病人为研究对象，采用单因素分析和Logistic回归分析筛选ICU病人发生急性皮肤衰竭的影响因素，构建 ICU病人急性皮肤衰竭风险预测模型，并对模型进行验证。

结果

377例病人中，89例发生急性皮肤衰竭，发生率为23.6%；Logistic回归分析结果显示，年龄、脓毒症、外周灌注指数（PPI）、血清白蛋白和使用血管活性药物是急性皮肤衰竭的影响因素。基于以上因素建立的列线图模型受试者工作特征曲线下面积为0.890，灵敏度为89.2%，特异度78.2%。H-L检验显示，χ2=6.462，P=0.290。

结论

构建的ICU病人急性皮肤衰竭风险预测模型具有良好的预测效能，可作为临床早期识别高危人群的有效工具。

急性皮肤衰竭  /  重症监护室  /  影响因素  /  预测模型  /  回顾性研究
Objective

To explore the risk factors for acute skin failure patients in intensive care unit(ICU) and to construct a predictive model.

Methods

A total of 377 ICU patients from a tertiary grade A hospital between January 2021 and December 2023 were selected as the study subjects.Univariate analysis and Logistic regression analysis were used to identify the influencing factors for acute skin failure patients in ICU,based on which a risk prediction model was constructed and subsequently validated.

Results

Among the 377 patients,89 developed acute skin failure,yielding an incidence rate of 23.6%.The Logistic regression analysis identified age,sepsis,peripheral perfusion index(PPI) use,albumin level,and vasopressor administration as significant influencing factors for acute skin failure.The area under the receiver operating characteristic curve for the Nomogram model established based on these factors was 0.890,with a sensitivity of 89.2% and a specificity of 78.2%.The Hosmer-Lemeshow test indicated a good model fit(χ²=6.462,P=0.290).

Conclusions

The constructed risk prediction model for acute skin failure patients in ICU demonstrates excellent predictive performance.The model could serve as an effective and practical tool for identifying high-risk patients.

acute skin failure  /  intensive care unit,ICU  /  influencing factors  /  prediction model  /  retrospective study
叶泉滟, 李国庆, 薛媛, 赵晓雨, 郭锦丽. ICU病人急性皮肤衰竭影响因素及预测模型构建. 护理研究, 2026 , 40 (13) : 2320 -2326 . DOI: 10.12102/j.issn.1009-6493.2026.13.018
Quanyan YE, Guoqing LI, Yuan XUE, Xiaoyu ZHAO, Jinli GUO. Analysis of influencing factors and construction of a prediction model for acute skin failure in ICU patients[J]. Chinese Nursing Research, 2026 , 40 (13) : 2320 -2326 . DOI: 10.12102/j.issn.1009-6493.2026.13.018
正文
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重症病人易出现皮肤完整性受损，但某些皮肤完整性受损是因低灌注引起的皮肤和皮下组织死亡，即急性皮肤衰竭(acute skin failure，ASF)[1]。重症监护病房(intensive care unit,ICU)是收治危重症病人的主要场所，该类病人具有病情危重、并发症多、灌注不足、组织氧合差等特点，是急性皮肤衰竭的高危人群[2-3]。一项研究表明，在每年超过500万例ICU病人中，急性皮肤衰竭的发病率为12%~42%[4]。急性皮肤衰竭的发生不仅延长ICU病人住院时间，还会增加死亡率。Cohen等[5]研究发现，急性皮肤衰竭病人死亡率高达42%。目前，医护人员主要凭借自身经验和/或肉眼观察可见的皮肤改变来评估病人急性皮肤衰竭发生风险[6]。在临床上，急性皮肤衰竭多归类于压力性损伤（pressure injury，PI），导致急性皮肤衰竭的误诊、漏诊现象严重，从而影响重症病人的皮肤护理质量[7]。本研究拟通过对ICU病人急性皮肤衰竭的独立危险因素进行分析，构建风险预测模型，为临床护理人员早期识别高危人群、采取个性化预防策略提供依据。
1　对象与方法
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1.1　研究对象
回顾性选择2021年1月—2023年12月山西省某三级甲等医院收入ICU治疗的病人。纳入标准：1）病人的年龄≥18岁；2）入住内科ICU、外科ICU 或综合ICU；3）入住ICU时长≥48 h；4）病历资料完整。排除标准：入住ICU前护理评估中出现皮肤破损或有全身皮肤炎症。本研究已通过我院伦理委员会批准 （编号：〔2024〕YX第203号）。
1.2　研究工具及方法
1.2.1　急性皮肤衰竭的诊断标准
依据急性皮肤衰竭的病理生理及各种皮肤灌注不足的临床表现[8]进行判定，即皮肤毛细血管动脉端灌注压<25 mmHg且皮肤任何部位短时间内出现边缘形状不规则的梨形、蝴蝶形或马蹄形的红色、紫色或黄黑色片状扁平斑块。
1.2.2　一般资料和临床资料收集表
通过文献回顾、小组讨论和专家函询形成ICU病人急性皮肤衰竭风险因素收集表。1）一般资料：主要包括年龄、性别、体质指数（body mass index,BMI）等；2）临床资料：主要包括体温、收缩压、外周灌注指数（peripheral perfusion index，PPI）、急性生理与慢性健康状况评分（APACHE-Ⅱ）、Braden 评分、序贯器官衰竭估计评分（SOFA）、里士满躁动-镇静评分（RASS）、格拉斯哥昏迷评分（GCS）、血清白蛋白、血糖、乳酸、机械通气时间、合并疾病、使用血管活性药物和镇静药物等。
1.3　资料收集方法
研究者根据自行设计的调查表进行收集，除一般资料收集入院时的数据外，对血清白蛋白值等实验室检查指标、APACHE-Ⅱ评分、SOFA评分等相关评分进行动态收集，综合病人在住院期间发生急性皮肤衰竭的动态临床指标和评分，选取最差值。涉及的疾病与治疗相关内容以医疗电子病历（护理记录单和医嘱治疗单）为标准。
1.4　统计学方法
采用Excel表格整理数据，进行双人录入、核对。采用SPSS25.0分析数据，采用R 4.2.3构建列线图模型。符合正态分布的定量资料以均数±标准差（x±s）表示，组间比较采用t检验；不符合正态分布的定量资料以中位数(四分位数)[M(P25,P75)]表示，组间比较采用秩和检验；定性资料以频数及百分比(%)表示，组间比较采用χ2检验、Fisher确切概率法或秩和检验。将单因素分析中差异有统计学意义的变量纳入多因素Logistic回归分析探讨影响因素，并构建列线图模型。采用Bootstrap法重复抽样1 000次，对列线图模型进行内部验证，分别采用H-L拟合优度检验和受试者工作特征（ROC）曲线评估模型校准度和区分度，并计算灵敏度和特异度。以P<0.05为差异有统计学意义。
2　结果
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2.1　ICU病人急性皮肤衰竭影响因素的单因素分析
377例病人中，89例发生急性皮肤衰竭，发生率为23.6%。将发生急性皮肤衰竭的病人设为发生组，未发生急性皮肤衰竭的病人设为未发生组，进行ICU病人发生急性皮肤衰竭影响因素的单因素分析。两组病人年龄、平均动脉压、PPI、Braden评分、APACHEⅡ评分、机械通气≥72 h、脓毒症、血管活性药使用、乳酸、血清白蛋白、白细胞计数等比较差异均有统计学意义（P<0.05）。见表1。
2.2　ICU病人急性皮肤衰竭影响因素的多因素分析
以是否发生急性皮肤衰竭（未发生=0，发生=1）为因变量，以单因素分析中差异有统计学意义的变量为自变量，进行Logistic回归分析。结果显示，年龄、脓毒症、血管加压药、PPI和白蛋白是ICU病人发生急性皮肤衰竭的影响因素。自变量赋值方式见表2。ICU病人发生急性皮肤衰竭影响因素的Logistic回归分析见表3。
2.3　ICU病人急性皮肤衰竭风险预测模型的构建
本研究基于年龄、脓毒症、使用血管活性药物、血清白蛋白、PPI 5项独立危险因素，建立预测ICU病人急性皮肤衰竭发生风险的列线图模型，见图1。
2.4　ICU病人急性皮肤衰竭风险预测模型的效能
采用ROC曲线下面积评估列线图模型的区分度，曲线下面积为0.890[95%CI（0.860，0.920）]，灵敏度为89.2%，特异度为78.2%。H-L检验显示拟合优度良好，χ2=6.462，P=0.290。ROC曲线见图2，校准图见图3。
3　讨论
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3.1　ICU 病人发生急性皮肤衰竭的影响因素
3.1.1　年龄越大的病人急性皮肤衰竭的发生风险更高
本研究发现，年龄与发生急性皮肤衰竭的风险呈正相关（OR=2.480）。Lee等[9]通过对4 301例病例进行回顾性分析发现，年龄≥65岁的急性皮肤衰竭病人占比72%。这一现象与免疫系统在皮肤屏障中的重要作用密切相关[10]。免疫系统不仅参与预防感染，还在组织受到脆弱、压迫、损伤或病原微生物侵袭时发挥关键作用，通过防止进一步损伤并启动愈合过程来维持皮肤的结构完整性[11]。然而，随着生理年龄的增加，免疫系统的功能逐渐减弱，这使得老年病人在皮肤屏障完整性和自身免疫性疾病方面变得更加脆弱[12]。老年病人的皮肤自我保护和抗压能力显著下降，增加了急性皮肤衰竭的发生风险，进而对临床结局产生直接影响，提高了死亡率。此外，老年病人常伴随虚弱和肌肉萎缩，这进一步增加了营养不良、功能衰退以及死亡风险。
3.1.2　脓毒症病人急性皮肤衰竭的发生风险更高
急性皮肤衰竭与脓毒症密切相关。本研究结果表明，脓毒症使急性皮肤衰竭的风险增加了4.831倍。脓毒症是一种由感染引起的严重疾病，可导致多器官功能障碍综合征(multiple organ dysfunction syndrome，MODS)，是ICU病人死亡的主要原因[13]。脓毒症导致炎症反应增强，从而引起微循环障碍、细胞损伤和器官功能障碍[13]。皮肤损伤可能是由炎症和微循环障碍引起的供氧减少引起的[14]，这与急性皮肤衰竭病理生理机制一致[15]。由于循环不稳定影响器官灌注，脓毒症病人发展为MODS，出现血流分布不均匀、内皮细胞损伤、组织氧供应不足[16]，从而导致细胞酸中毒、细胞功能受损，增加急性皮肤衰竭风险。此外，脓毒症病人通常需要长时间卧床休息和持续机械通气，这增加了皮肤损伤和压力损伤的风险[17]。因此，预防急性皮肤衰竭对于脓毒症的有效管理至关重要。
3.1.3　长时间使用血管活性药物病人急性皮肤衰竭发生风险更高
持续使用血管活性药物是与急性皮肤衰竭相关的一个重要风险因素[18]。本研究发现，使用血管活性药物可使急性皮肤衰竭风险增加3.731倍。George等[19]发现使用2种以上的血管加压药或正性肌力药物治疗的重症病人急性皮肤衰竭的发生率是100%。血管加压剂在危重病病人中被广泛应用，以提高血压并改善中枢器官的灌注，但同时将血流从皮肤转移，可能对组织的机械特性产生影响，并增加皮肤对更高机械负荷的敏感性[20]，这种生理变化可能导致病人急性皮肤衰竭风险的增加。研究发现，血管紧张素转化酶抑制剂和血管紧张素Ⅱ受体阻滞剂是引起急性皮肤衰竭的最常见药物类别[21]。血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体阻滞剂可降低组织氧合，并导致皮肤内皮细胞损伤和微血管痉挛，从而增加急性皮肤衰竭的风险[22]。然而，鉴于血管活性药物的类型和用途以及它们与其他因素的相互作用的差异，需要进一步的研究来阐明血管活性药物与急性皮肤衰竭之间的关系。
3.1.4　PPI值是ICU病人发生急性皮肤衰竭的独立危险因素
PPI是用于监测皮肤组织中的血流以评估局部组织灌注的指标。ICU监护设备可监测PPI，PPI值越高表示血流灌注越好。有研究指出，PPI值与急性皮肤衰竭的发生率和严重程度呈负相关[23]。有研究发现，PPI值<1.4的病人发生急性皮肤衰竭的相对风险较高。在本研究中，PPI值与急性皮肤衰竭风险呈负相关（OR=0.392），PPI值<1.5的ICU病人发生急性皮肤衰竭的可能性更大[24]。总之，PPI值可能是危重症病人急性皮肤衰竭风险的有价值预测因子。但重症护理人员忽视了PPI变化趋势的评估在预防皮肤损伤风险中的作用，未将皮肤视为脏器进行灌注功能评估，对低灌注的理念仍局限于中心循环[25-26]，提示应积极提高护理人员对PPI的重视程度，将PPI设置为监护仪界面的默认显示参数，同时将该参数自动导入重症护理记录单，为医疗和护理决策提供信息。
3.1.5　低白蛋白血症是ICU病人急性皮肤衰竭发生的影响因素
低白蛋白血症与急性皮肤衰竭的发生率相关，是急性皮肤衰竭的一个独立风险因素[27]。在本研究中，发现白蛋白水平与急性皮肤衰竭风险呈负相关（OR=0.199）。低白蛋白血症与急性皮肤衰竭的发病机制密切相关。ICU病人常常伴随胰岛素抵抗和肌肉蛋白分解的增加[28]，这导致机体长期处于应激、高代谢和负氮平衡状态，从而引发营养受损等问题。Curry等[29]研究发现，血清白蛋白水平低于35 g/L与急性皮肤衰竭密切相关。低白蛋白血症通过削弱皮肤屏障的各级功能，降低皮肤对外界挑战的适应能力，从而增加急性皮肤衰竭的发生率。此外，低白蛋白血症是水肿的常见原因[30]。水肿会导致组织结构变形，妨碍营养物质的输送和废物的清除，从而提高皮肤衰竭的易感性[31-32]。因此，适当的营养支持和营养结构调整对于ICU病人显得尤为重要，以预防低白蛋白血症的发生。
3.2　ICU病人发生急性皮肤衰竭风险列线图预测模型的构建和应用
本研究构建的ICU病人急性皮肤衰竭发生风险预测模型具有较好的区分度、校准度、灵敏度及特异度，基于该模型的校准图显示，列线图模型预测的概率与实际观察形成的概率一致性较好。列线图模型能将 Logistic 回归分析结果可视化，可整合更多预测因素，更直观地对个体危险因素进行预测，应用也更加灵活[33]。现阶段，国内外尚未形成尺度统一的ICU病人急性皮肤衰竭危险因素评估工具。目前，临床压力性损伤大多采用评估量表评估急性皮肤衰竭发生情况，主要为Braden量表、Waterlow量表和Norton量表[34]。但这些量表并不完全适用于急性皮肤衰竭的风险评估，主要原因在于：急性皮肤衰竭与压力性损伤的病因与发病机制存在显著差异。目前，有少量临床风险预测模型研究涉及急性皮肤衰竭，可借鉴Delmore等[35]构建的模型，尽管该模型ROC曲线下面积在开发人群和验证人群中分别为0.864和0.861，但该预测模型开发过程欠规范，预测准确性有待提高。因各项研究设计存在各种差异，ICU病人急性皮肤衰竭风险预测模型的有效性及外推性仍需进一步开发与验证。
4　小结
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本研究基于年龄、脓毒症、血管活性药物使用情况、血清白蛋白、PPI构建了ICU病人急性皮肤衰竭风险列线图模型，具有较好的区分度和准确度，为早期识别和预防其风险发生提供了量化可行的测评工具。本研究不足在于：首先，本研究为回顾性研究，存在选择偏倚；其次，急性皮肤衰竭缺乏明显的诊断和特异性因素，且本研究在同一所医院完成，使研究结果的可推广性受限；最后，本研究的样本量偏少，可能会影响因素分析结果。

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2026年第40卷第13期
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doi: 10.12102/j.issn.1009-6493.2026.13.018
  • 接收时间：2025-04-09
  • 首发时间：2026-10-30
  • 出版时间：2026-07-10
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  • 收稿日期：2025-04-09
  • 修回日期：2026-06-01
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    1山西医科大学护理学院，山西 030001
    2山西医科大学第二医院

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郭锦丽，E-mail：
GUO Jinli, E-mail:
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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