感染性休克早期预警评估模型在异基因造血干细胞移植中的应用  

Establishment of an early warning evaluation model for septic shock in allogeneic hematopoietic stem cell transplantation and its application

作　　者：张旭[1] 闫金松[1] 巩小丽 姚欢欢 张静静[1] ZHANG Xu;YAN Jinsong;GONG Xiaoli;YAO Huanhuan;ZHANG Jingjing(Department of Hematology,Dalian Key Laboratory of Hematology,Liaoning Medical Center for Hematopoietic Stem Cell Transplantation,Liaoning Key Laboratory of Hematopoietic Stem Cell Transplantation and Translational Medicine,of the Second Hospital of Dalian Medical University,Dalian 116027,Liaoning,China)

机构地区：[1]大连医科大学附属第二医院血液科,大连市血液病重点实验室,辽宁省造血干细胞移植医学中心,辽宁省造血干细胞移植临床转化医学研究重点实验室,辽宁大连116027

出　　处：《护士进修杂志》2022年第18期1655-1660,共6页Journal of Nurses Training

基　　金：辽宁省重点研发指导计划(编号:2019JH8110300027)。

摘　　要：目的基于患者病情变化情况,构建具有科学性、实用性的异基因造血干细胞移植allo-HSCT过程中感染性休克早期预警模型,并对模型预测效果进行验证。方法采用专家讨论结合临床实际情况,参考NEWS和VIEWS评分确定预警评分表,并回顾性纳入2019年1月—2021年1月在我院接受allo-HSCT的患者共110例进行统计学分析,通过单因素分析、最优尺度回归筛选出患者感染性休克先兆的独立危险因素,形成早期预警评估模型。结果最优尺度回归分析结果显示异基因造血干细胞移植过程中感染性休克早期预警模型共纳入11项指标,包括输血次数、粒缺期感染灶等,对11项指标根据严重程度或最佳截断值进行赋分,确定总分为0~30分;根据ROC曲线和Youden指数确定早期预警模型的最佳截断值,在截断点14.5,评估模型对感染性休克预测的灵敏度为88%,特异度为92.6%。结论本研究构建的异基因造血干细胞移植过程中感染性休克早期预警模型能够有效地识别出患者感染性休克的先兆,为医护对患者采取预见性干预措施提供有效的参考依据。Objective To establish a scientific and practical model for early warning of septic shock during allogeneic hematopoietic stem cell transplantation(allo-HSCT)based on the changes of patients’conditions,and to verify the prediction effect of the model.Methods A total of 110 patients who received allo-HSCT in our hospital from January 2019 to January 2021 were retrospectively included for statistical analysis by using expert discussion combined with clinical reality and referring to NEWS and VIEWS scores to determine the early warning rating scale.Single factor analysis and optimal scale regression were used to screen the independent risk factors for the early warning of septic shock,and an early warning evaluation model was formed.Results The results of optimal scale regression analysis showed that a total of 11 indexes were included in the early warning model of septic shock during allo-HSCT,including the number of blood transfusion and the infective focus in the granulose-deficiency stage,etc.The 11 indexes were assigned according to the severity or the best cutoff point,with a total score of 0 to 30 points.The optimal cutoff point of the early warning model was determined according to the ROC curve and Youden index,and at the cutoff point 14.5,the sensitivity and specificity of the evaluation model for the prediction of septic shock were 88%and 92.6%,respectively.Conclusion The early warning model of septic shock during allo-HSCT in this study can effectively identify the precursors of septic shock in patients and provide an effective reference for medical and clinical workers to take predictive intervention measures for patients.

关 键 词：造血干细胞移植 感染性休克 预警模型 护理 

分 类 号：R473.55[医药卫生—护理学]