维持性血液透析患者动静脉内瘘分级的简易模型构建  

Simple model construction of arteriovenous fistula classification in maintenance hemodialysis patients

作　　者：邹兆华 卿伟[1] 唐利群[1] 张真[1] 朱茂才[1] Zou Zhaohua;Qing Wei;Tang Liqun;Zhang Zhen;Zhu Maocai(Department of Blood Purification Center,People′s Hospital of Deyang City,Deyang 618000,China)

机构地区：[1]德阳市人民医院血液净化中心,德阳618000

出　　处：《中国实用护理杂志》2023年第5期374-378,共5页Chinese Journal of Practical Nursing

摘　　要：目的构建动静脉内瘘分级的简易模型,实现对血液透析患者的动静脉内瘘分级。方法本研究为回顾性分析,便利抽样法选取2016年1月至2021年1月在德阳市人民医院血液透析的内瘘患者304例,根据内瘘是否功能障碍,分为内瘘失功组64例和内瘘通畅组240例。通过单因素分析和Logistic回归分析,获得内瘘失功的独立影响因素及其回归系数,以回归系数为基础建立风险评分公式,形成内瘘分级的简易模型。通过受试者工作特征曲线评估模型并确定内瘘分级的评分标准。结果Logistic回归分析显示糖尿病、低血压、年龄≥60岁、压迫时间≥30 min、血磷>1.78 mmol/L、三酰甘油>1.71 mmol/L和纤维蛋白原>4 g/L是内瘘失功的独立影响因素(均P<0.05)。ROC曲线下面积为0.858(95%CI 0.789~0.928,P<0.01),内瘘分级评分的最佳临界值为7.5时,该模型的敏感度为80.4%,特异度为84.8%。结论通过获得内瘘失功的预测因子,进行风险评分,构建内瘘分级的简易模型,能够有效预测内瘘失功风险。有利于实施内瘘分级管理和能级对应穿刺,保障患者的通路安全。Objective To construct a simple model of arteriovenous fistula classification,and to achieve the classification of arteriovenous fistula in hemodialysis patients.Methods The study was a retrospective analysis,a total of 304 hemodialysis patients with internal fistula in People′s Hospital of Deyang City from January 2016 to January 2021 were selected by convenience sampling method,depending on whether the internal fistula was dysfunctional,patients were divided into 64 in the internal fistula failure group and 240 in the internal fistula patency group.Independent influence factors and their regression coefficient were obtained by single-factor analysis and logistic regression analysis,The risk score formula was established based on the regression coefficient to form a simple model of internal fistula classification.The model was evaluated by receiver operating characteristic curve and the scoring criteria for internal fistula classification was determined.Results Logistic regression analysis showed that diabetes mellitus,hypotension,age≥60 years old,compression time≥30 min,blood phosphorus>1.78 mmol/L,triglyceride>1.71 mmol/L and fibrinogen>4 g/L were independent influencing factors of internal fistula failure(all P<0.05).The area under the receiver operating characteristic curve was 0.858(95%CI 0.789-0.928,P<0.01),and the best critical value of the internal fistula classification was 7.5,the sensitivity was 80.4%and the specificity was 84.8%.Conclusions By obtaining the predictors of internal fistula failure,conducted the risk score,and constructed a simple model of internal fistula classification,which can effectively predicted the risk of internal fistula failure.It is conducive to the implementation of internal fistula classification management and the puncture of corresponding grade,to ensure the pathway safety of patients.

关 键 词：分级 LOGISTIC模型 ROC曲线 血液透析 动静脉内瘘 

分 类 号：R473.5[医药卫生—护理学]