股动脉穿刺处出血性并发症相关危险因素分析及风险评分表构建  

Analysis of risk factors and construction of prediction a risk score scale of hemorrhagic complications at the puncture site after cerebrovascular intervention with femoral artery access

作　　者：景毅鹏 孙晓祯 底瑞青[2] 周纪妹 邓鑫[1] Jing Yipeng;Sun Xiaozhen;Di Ruiqing;Zhou Jimei;Deng Xin(Neuro-intervention Department,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Nursing Department,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院神经介入科,郑州450000 [2]郑州大学第一附属医院护理部,郑州450000

出　　处：《中国实用护理杂志》2022年第33期2581-2587,共7页Chinese Journal of Practical Nursing

基　　金：河南省高等学校重点科研项目计划(20A320084)。

摘　　要：目的分析股动脉入路脑血管介入术后穿刺处出血性并发症相关危险因素,并构建出血风险评分表。方法选取2020年4—10月在郑州大学第一附属医院神经介入科病区行股动脉穿刺介入手术的患者215例为研究对象,其中并发症组60例,无出血性并发症者155例作为对照组。将患者一般资料、介入手术相关资料及实验室检查进行单因素分析后纳入二元多因素Logistic回归分析确定独立危险因素,根据回归模型构建出血风险评分表。结果与对照组相比,并发症组女性、糖尿病、降糖药物的使用、抗凝/抗血小板药物使用比例和躁动发生率显著增加,差异有统计学意义(χ^(2)值为4.94~15.81,均P<0.05);并发症组年龄、BMI、HbA1c、凝血酶原时间活动度、鞘管尺寸及手术时间高于对照组,凝血酶原时间及肌酐值低于对照组,差异有统计学意义(t值分别为-6.25~2.80,均P<0.05)。多因素Logistic回归分析显示:性别(OR=0.090,95%CI 0.025~0.302)、BMI(OR=1.736,95%CI 1.462~2.115)、HbA1c(OR=1.775,95%CI 1.107~2.845)、抗凝/抗血小板药物的使用(OR=0.082,95%CI 0.015~0.448)及手术时间(OR=1.031,95%CI 1.012~1.052)是出血性并发症的独立危险因素。在风险评分表中:总分为-3~13分,分值≥5分时存在风险,该评分表灵敏度为83.3%,特异度为92.3%,ROC曲线下面积为0.878(P<0.001,95%CI 0.818~0.938)。结论女性、高BMI、高HbA1c、抗凝/抗血小板药物使用及手术时间长可使股动脉穿刺处出血性并发症发生风险增加。该预测模型预测性能较好,可以推广使用。Objective To analyze the risk factors associated with hemorrhagic complications at the puncture site after femoral artery access cerebrovascular interventions and construct a bleeding risk scale.Methods Two hundred and fifteen patients who underwent femoral artery puncture interventions in the neurointerventional department ward of the First Affiliated Hospital of Zhengzhou University from April to October 2020 were selected for the study,including 60 cases in the complication group and 155 cases in the control group.The patients′general data,interventional procedure-related data and laboratory tests were analyzed univariately and then incorporated into a binary multi-factor logistic regression analysis to determine independent risk factors,and a bleeding risk scale was constructed according to the regression model.Results Compared with the control group,there was a statistically significant increase in the incidence of women,diabetes mellitus,use of glucose-lowering drugs,proportion of(anticoagulant/antiplatelet drugs)use and irritability in the complication group(χ^(2) values were 4.94-15.81,all P<0.05);age,BMI,HbA1c,prothrombin time activity,and sheath size and operative time were higher than those of the control group,and prothrombin time and creatinine values were lower than those of the control group,with statistically significant differences(t values of-6.25 to 2.80,respectively,all P<0.05).Multifactorial logistic regression analysis showed that gender(OR=0.09,95%CI 0.025-0.302),BMI(OR=1.736,95%CI 1.462-2.115),HbA1c(OR=1.775,95%CI 1.107-2.845),and use of anticoagulant/antiplatelet drugs(OR=0.082,95%CI 0.015-0.448)and time to surgery(OR=1.031,95%CI 1.012-1.052)were independent risk factors for bleeding complications.In the risk scale:the total score was-3 to 13,and risk existed for a score≥5.The sensitivity of this scale was 83.3%,the specificity was 92.3%,and the area under the ROC curve was 0.878(P<0.001,95%CI 0.818 to 0.938).Conclusions Female,high BMI,high HbA1c,anticoagulant/antiplatelet drug use,

关 键 词：股动脉 危险因素 出血性并发症 评分表 

分 类 号：R743[医药卫生—神经病学与精神病学]