胸外科老年患者PICC相关性血栓形成风险评估模型的构建及应用检验  

Construction and application test of PICC-related thrombosis risk assessment model in elderly patients in thoracic surgery

作　　者：黄晓丹[1] 卫建宁[1] HUANG Xiaodan;WEI Jianning(Guangzhou First People's Hospital,Guangzhou 510180)

机构地区：[1]广东省广州市第一人民医院胸外科,广州510180

出　　处：《临床护理杂志》2023年第2期5-9,共5页Journal of Clinical Nursing

基　　金：广东省医学科学技术研究基金项目(B2020006)。

摘　　要：目的构建胸外科老年患者PICC相关性血栓形成风险评估模型,并检验其预测效果。方法采用便利抽样法,选择2019年1月-2021年12月我科收治的老年患者200例为研究对象,借助一般资料问卷收集患者临床资料,统计形成PICC相关性血栓例数;采用单因素分析、多因素Logistic回归分析筛选PICC相关性血栓形成的危险因素;基于回归分析结果构建PICC相关性血栓形成风险评估模型,并检验模型预测准确率。结果200例胸外科老年患者中形成PICC相关性血栓28例,形成率为14.00%;多因素Logistic回归分析结果显示,胸外科老年患者PICC相关性血栓形成的独立危险因素为合并糖尿病、D-二聚体≥0.5mg/L、导管尖端位置上腔静脉上2/3、导管直径/静脉直径≥67%、穿刺次数>1次、护士工作年限<8年、置管宣教缺失(P<0.05)。Hosmer-Lemeshow检验结果显示,评估模型拟合优度良好(χ^(2)=0.481,P=0.488),ROC曲线下面积为0.904,95%CI为0.859~0.949,最大约登指数为0.600,灵敏度、特异度分别为71.40%、88.60%;模型预测准确率为91.25%。结论胸外科PICC置管老年患者伴有不同程度的相关性血栓形成风险,且PICC相关性血栓形成危险因素复杂,根据回归分析结果构建的风险评估模型,能实现对胸外科老年患者PICC相关性血栓形成风险的准确、有效评估,为临床预防护理提供参考。Objective To construct a risk assessment model for PICC-related thrombosis in elderly patients with thoracic surgery,and to test its assessment effect through clinical application.Methods A total of 200 elderly patients admitted to the Department of Thoracic Surgery from January 2019 to December 2021were selected by the convenience sampling method as the research subjects.The clinical data of the patients were collected by means of the general information questionnaire,and the number of patients with PICC-related thrombosis was diagnosed and counted.Univariate analysis and multivariate logistic regression analysis were used to screen the risk factors of PICC-related thrombosis in elderly patients in thoracic surgery.Based on the regression analysis results,a PICC-related thrombosis risk assessment model was constructed,and the model was used to assess the risk of PICC-related thrombosis in clinical patients,calculate its prediction accuracy.Results After diagnosis and statistics,there were 28 elderly patients with PICC-related thrombosis in thoracic surgery,with a formation rate of 14.00%.Multivariate logistic regression analysis showed that the independent risk factors of PICC-related thrombosis in elderly patients with thoracic surgery included diabetes mellitus,D-dimer≥0.5 mg/L,catheter tip position on the superior 2/3 of the superior vena cava,catheter diameter/vein diameter≥67%,puncture times>1 time,nurse working years<8 years,lack of education about catheter placement(P<0.05).The Hosmer-Lemeshow test showed that the goodness of fit of the PICC-related thrombosis risk assessment model in elderly patients with thoracic surgery was good(χ^(2)=0.481,P=0.488).The ROC curve analysis showed that the area under the ROC curve was 0.904,and the 95%CI was 0.859~0.949,the maximum Youden index was 0.600,the sensitivity and specificity were 71.40%and 88.60%,respectively;the clinical application showed that the model evaluation accuracy was 91.25%.Conclusions Elderly patients with PICC catheterization in thoracic sur

关 键 词：胸外科疾病 PICC相关性血栓形成 风险评估模型 老年人 

分 类 号：R655[医药卫生—外科学] R540.46[医药卫生—临床医学]