老年住院患者PICC相关深静脉血栓风险评估模型研究  

A risk assessment model for Peripherally Inserted Central Catheter related deep vein thrombosis in elderly inpatients

作　　者：刘芬[1,2] 郭豫涛[1] 徐月[1] 刘心菊 李燕[1] 侯惠如[1] LIU Fen GUO Yutao XU Yue LIU Xinju LI Yan HOU Huiru(Chinese PLA General Hospital, Beijing, 100853, China)

机构地区：[1]解放军总医院南楼临床部,北京市100853 [2]联参警卫局卫生保健处

出　　处：《中国护理管理》2017年第4期462-466,共5页Chinese Nursing Management

基　　金：总后勤部卫生部保健专项科研课题(14BJZ05)

摘　　要：目的:确定PICC-DVT高危因素,构建PICC-DVT风险评估模型。方法:回顾性分析2008年1月至2015年12月在我院行PICC置管的564例老年患者资料。应用Cox比例风险模型确定PICC-DVT危险因素并建立风险评估模型;用Jonckheere趋势检验评估不同危险分层患者PICC-DVT差异,并通过构建受试者工作特征曲线(ROC),评价模型预测价值。结果:房颤、动脉粥样硬化、近期手术史、静脉血栓史是老年住院患者PICC-DVT的独立危险因素(P<0.05)。PICC-DVT风险指数=1.302χ1(静脉血栓史)+0.775χ2(近期手术史)+0.596χ3(房颤)+0.610χ4(动脉粥样硬化)。PICC-DVT发生率随风险指数升高而增加(P<0.05)。该模型ROC曲线下面积为0.73。结论:房颤、动脉粥样硬化、近期手术史、静脉血栓史是老年住院患者PICC-DVT的独立危险因素,PICC-DVT风险评估模型预测效能良好。Objective： To identify risk factors for Peripherally Inserted Central Catheter （PICC）-related Deep Vein Thrombosis （DVT） in elderly inpatients and develop a predict model of PICC-DVT. Methods： The data from 564 elderly inpatients receiving a PICC in PLA General Hospital between January 2008 and December 2015 were retrospectively analyzed. Cox proportional hazards model was used to identify risk factors and develop the PICC-DVT risk assessment model. The patients were stratified by risk of PICC-DVT using Jonckheere trend test. The model was evaluated by receiver operating characteristic curve （ROC）. Results： Atrial fibrillation （AF）, atherosclerosis, recent operation and prior vein thrombosis （VTE） were the key risk factors （P〈0.05）. PICC-DVT risk index=1.302x1 （prior VTE） ＋0.775x2（recent operation）＋0.596x3 （AF）＋0.610x 4 （atherosclerosis）. With the increase of risk index, the incident of PICC-DVT increased significantly. The area below the ROC curve of the model was 0.73. Conclusion： AF, atherosclerosis, recent operation and prior VTE were the independent risk factors of PICC-DVT. The predict model is reliable in predicting PICC-related deep venous thrombosis.

关 键 词：经外周静脉穿刺中心静脉导管 深静脉血栓 危险因素 预测模型 

分 类 号：R47[医药卫生—护理学]