活动性癫痫患儿丙戊酸治疗效果风险预警模型的构建及相关护理措施探讨  

Establishment of a risk prediction model for valproic acid treatment effect in children with active epilepsy and related nursing measures investigation

作　　者：景秋霞 俞小平[1] 黄玉芬[1] 蔡美笑[1] 何方方 JING Qiuxia;YU Xiaoping;HUANG Yufen;CAI Meixiao;HE Fangfang(The Children's Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou,Zhejiang 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院,浙江杭州310052

出　　处：《中国优生与遗传杂志》2021年第12期1777-1781,共5页Chinese Journal of Birth Health & Heredity

摘　　要：目的构建活动性癫痫患儿丙戊酸治疗效果风险预警模型并对相关护理措施进行探讨。方法回顾性分析2019年1月至2020年12月于我院服用丙戊酸治疗并出院后随访满6个月的活动性癫痫患儿的临床资料,将患儿的年龄、性别、BMI、病程、入组前一年内发病频率、接受护理指导的依从性、丙戊酸血药浓度达标情况与随访期间丙戊酸治疗效果进行单因素分析,并建立Logistic回归模型筛选患儿随访期间丙戊酸治疗效果的独立影响因素,根据筛选出的独立影响因素建立列线图预警模型,并对相关护理措施进行探讨。结果138例服用丙戊酸治疗的患儿经随访6个月发现治疗有效者91例,无效者47例,其中患儿的病程(OR=3.392,95%CI:2.249~5.115)、入组前一年内发病频率(OR=3.666,95%CI:2.436~5.517)、接受护理指导的依从性(OR=2.081,95%CI:1.350~3.212)、丙戊酸血药浓度达标情况(OR=10.326,95%CI:2.863~37.244)为随访期间丙戊酸治疗效果的独立影响因素,根据所筛选出的4项独立影响因素,建立了能够预测活动性癫痫患儿丙戊酸治疗效果的列线图风险预警模型,该模型的C-index为0.902,表明该列线图预警模型具有良好的区分度,对该模型进行内部验证后发现预测值和观察值基本一致,表明该列线图预警模型具有良好的一致性。结论本研究通过筛选出活动性癫痫患儿丙戊酸治疗效果的独立影响因素建立了能够预测丙戊酸治疗效果的列线图预警模型,该列线图预警模型有着良好的区分度及一致性,具有较高的临床应用价值,对甄别服用丙戊酸治疗效果不佳的高风险患儿,针对相关危险因素制定有效的护理干预措施有着较为重要的指导意义。Objective to establish a risk prediction model for valproic acid treatment effect in children with active epilepsy and investigate related nursing measures. Methods From January 2019 to December 2020, the clinical data of children with active epilepsy who received valproic acid treatment and follow-up for 6 months after discharge in our hospital were retrospectively analyzed. Univariate analysis was conducted with the age, gender, body mass index(BMI), course of disease,frequency of illness within one year before enrollment, compliance of nursing instructions, blood concentration of valproic acid reaching the standard and effect of valproic acid treatment during follow-up. Logistic regression model was established to screen the independent influencing factors of valproic acid treatment effect during the follow-up period of children. According to the screened independent influencing factors, a risk prediction model was established and relevant nursing measures were investigated. Results 138 children treated with valproic acid and followed up for 6 months. Among which, 91 cases were found to be effective, 47 cases were ineffective. Course of disease(OR=3.392, 95%CI: 2.249-5.115), frequency of illness within one year before enrollment(OR=3.666, 95%CI: 2.436-5.517), compliance of nursing instructions(OR=2.081, 95%CI:1.350-3.212), and blood concentration of valproic acid reaching standard(OR=10.326, 95%CI: 2.863-37.244) were independent influencing factors for the effect of valproic acid treatment. According to the four screening independent influencing factors, a nomogram prediction model for the effect of valproic acid treatment in children with active epilepsy was established.The C-index of the model was 0.902, indicating that the nomogram model had a good discrimination. The internal validation of the model showed that the predicted and the observed values were basically consistent, indicating that the nomogram prediction model had a good consistency. Conclusion The nomogram model based on the independent influenc

关 键 词：活动性癫痫 丙戊酸 影响因素 风险预警模型 护理措施 

分 类 号：R473.74[医药卫生—护理学]