室间隔缺损封堵术后穿刺血管并发症发生风险预测模型的构建及其效果检验  

Construction of risk prediction model for vascular complications after closure of ventricular septal defect and its effect test

作　　者：孟建朝[1] 宋青青[1] 张弦[1] MENG Jianchao;SONG Qingqing;ZHANG Xian(Hunan Provincial Children's Hospital,Changsha,410000,China)

机构地区：[1]湖南省儿童医院心血管内科,湖南省长沙市410000

出　　处：《护理实践与研究》2023年第6期846-851,共6页Nursing Practice and Research

摘　　要：目的构建室间隔缺损(VSD)封堵术后穿刺血管并发症发生风险预测模型,并分析模型预测效果。方法选择医院2020年1月—2022年1月收治的行室间隔缺损封堵术的先天性心脏病(CHD)患儿共100例为调查对象,通过回顾性分析,梳理患儿基本人口学资料、病历等,以获取变量信息,结合诊断、分析结果,统计术后穿刺血管并发症发生例数,通过单因素分析、多因素Logistic回归分析筛选术后穿刺血管并发症发生的影响因素。结合回归分析结果,构建风险预测模型,并经受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)分析、外部应用检验模型预测效果。结果经诊断、统计得到,术后穿刺血管并发症患儿9例,发生率为9.00%;单因素分析显示,VSD封堵术患儿术后穿刺血管并发症发生的影响因素有年龄、穿刺方法、穿刺次数、穿刺按压方式、大导管鞘、肢体制动时间、术前使用抗凝药(P<0.05);经多因素Logistic回归分析得到,先天性心脏病室间隔缺损封堵术患儿术后穿刺血管并发症发生的影响因素有年龄<3岁、穿刺次数>2次、体表解剖定位穿刺、穿刺后人工按压、大导管鞘、术前使用抗凝药(P<0.05)。预测VSD封堵术后穿刺血管并发症的ROC曲线下面积为0.842,95%CI为0.789~0.894,最大约登指数为0.553,对应灵敏度、特异度系数分别为0.694、0.859;外部验证显示,模型预测准确率为91.67%。结论CHD-VSD患儿封堵术后存在血管并发症风险,年龄<3岁、穿刺次数>2次、体表解剖定位穿刺、穿刺后人工按压、大导管鞘、术前使用抗凝药的患儿发生穿刺血管并发症的可能性较大。基于回归分析结果构建的风险预测模型能有效识别影响因素,配合临床预防护理干预,能降低穿刺血管并发症风险,促进康复进程。Objective To establish a risk prediction model for vascular complications after ventricular septal defect(VSD)occlusion,and analyze the prediction effect of the model.Methods A total of 100 children with congenital heart disease(CHD)who underwent ventricular septal defect occlusion in the hospital from January 2020 to January 2022 were selected as the subjects of investigation.Through retrospective analysis,the basic demographic data and medical records of the children were sorted out to obtain variable information.Combined with the diagnosis and analysis results,the number of cases of vascular complications after puncture was counted.Through single factor analysis Multivariate Logistic regression analysis was used to screen the factors influencing the occurrence of vascular complications after operation.Combined with the results of regression analysis,the risk prediction model is constructed,and the prediction effect of the model is tested by receiver operating characteristic(ROC)curve analysis and external application.Results According to the diagnosis and statistics,there were 9 children with vascular complications after operation,the incidence was 9.00%.Univariate analysis showed that the influencing factors of vascular complications after VSD in children include age,puncture method,puncture times,puncture pressing method,large catheter sheath,limb immobilization time,and preoperative use of anticoagulants(P<0.05).Multivariate Logistic regression analysis showed that the influencing factors of vascular complications after VSD in children with CHD include age<3 years old,puncture times>2,anatomical positioning puncture,manual compression after puncture,large catheter sheath,and preoperative use of anticoagulants(P<0.05).The area under the ROC curve for predicting vascular complications after VSD occlusion was 0.842,95%CI was 0.789~0.894,the maximum Yoden index was 0.553,and the corresponding sensitivity and specifi city coeffi cients were 0.694 and 0.859,respectively;external validation shows that the accuracy

关 键 词：先天性心脏病 室间隔缺损封堵术 穿刺部位 血管并发症 预测模型 

分 类 号：R473.5[医药卫生—护理学]