连续性血液净化治疗体外循环堵管风险积分模型的构建  

A prognostic model for predicting extracorporeal circuit clotting in patients with continuous renal replacement therapy

作　　者：何朝生[1,2,3] 符霞[2,3] 梁馨苓[2,3] 宋利[2,3] 史伟[2,3] 

机构地区：[1]南方医科大学,广东广州510515 [2]广东省人民医院肾内科,广东广州510080 [3]广东省医学科学院,广东广州510080

出　　处：《南方医科大学学报》2015年第2期272-275,共4页Journal of Southern Medical University

基　　金：国家十二五科技支撑项目(2011BAI10B08);广东省科技计划项目(2010B031600157)

摘　　要：目的构建24 h连续性血液净化治疗患者的体外循环堵管风险积分模型。方法研究对象为425例连续性血液净化治疗的患者,其中302例用于建立体外循环堵管风险积分模型,103例用来验证该模型,观察终点为CRRT体外循环管路堵塞。所有数据采用SPSS 17.0软件包进行统计分析。结果 24 h CRRT体外循环堵塞的风险积分模型的风险评分为0~5分。模型积分系统的ROC曲线下面积0.790（95%CI 0.719~0.826）,P〈0.001,可较好地判断24 h内CRRT体外循环是否会堵塞。检验结果显示,CRRT体外循环堵管预测积分模型的拟合度良好,预测堵管的发生率与实际堵管发生率无统计学差异（R2=0.301,P=0.232）。验证组病例中低危、中危和高危三组体外循环管路的生存时间有显著性差异（P〈0.05）。结论连续性血液净化治疗体外循环堵管风险积分模型,包括血流量不足、无抗凝剂治疗、HCT、LAC和APTT值等可以预测治疗过程中可能发生的堵管问题。根据预测可及时提前进行干预处理,减少了意外不良事件的发生。Objective To establish a prognostic model for predicting extracorporeal circulation clotting in patients with continuous renal replacement therapy（CRRT）. Methods 425 patients with CRRT were involved in the study. We built a predictive risk model of extracorporeal blood clotting with the 302 participants, and 103 participants were used to validate the model. The primary endpoint of CRRT was extracorporeal circulation pipe blockage. Results We used a score of 0- 5 point evaluating system to predict the risk of 24 hours CRRT integral model of cardiopulmonary bypass clogging. The area under the CRRT predictive model of cardiopulmonary bypass clogging integral system ROC curve was 0.790（95% CI 0.719-0.826）（P〈0.001）. The evaluating system can determine the blockage of 24 hours CRRT extracorporeal circulation. The results showed that CRRT extracorporeal plugging prediction fitted the integral model and could predict the chance of plugging. The actual plugging rate showed no significant difference from the predicted rate（R2=0.301, P=0.232）. The cardiopulmonary pipe survival time between the 3 groups（low risk, intermediate risk, and high risk） showed a significant difference（P〈0.05）. Conclusion We established a continuity extracorporeal blood purification plugging risk score model, to predict plugging risks during CRRT treatment.

关 键 词：连续性血液净化 体外循环 凝血 积分模型 

分 类 号：R459.5[医药卫生—治疗学]