儿童血液净化股静脉置管并发症风险预测模型的构建与验证  

Establishment and validation of a risk prediction model for complications related to femoral vein catheterization for blood purification in children

作　　者：张胜华[1,2] 江雨秋 李银 宋诗怡 唐静 胡燕[1,2] ZHANG Sheng-hua;JIANG Yu-qiu;LI Yin;SONG Shiyi;TANG Jing;HU Yan(Department of Pediatric Nephrology Nursing,West China Second University Hospital,Sichuan University/West China School of Nursing,Sichuan University,Chengdu 610011,China;Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,Chengdu 610011,China)

机构地区：[1]四川大学华西第二医院小儿肾脏科肾脏护理单元/四川大学华西护理学院,成都610011 [2]四川大学华西第二医院出生缺陷与相关妇儿疾病教育部重点实验室,成都610011

出　　处：《中国血液净化》2024年第1期62-66,共5页Chinese Journal of Blood Purification

摘　　要：目的首次构建儿童血液净化股静脉置管并发症的风险预测模型,并验证预测效果。方法选取2020年1月—2022年6月四川大学华西第二医院小儿肾脏科使用股静脉置管行血液净化治疗的患儿428例,行单因素和多因素Logistic回归分析股静脉置管并发症发生的危险因素,建立风险预测模型并使用列线图展示模型。采用ROC曲线、校准曲线评价模型的区分度和校准度,以2022年7月—10月50例患儿资料进行模型的外部验证。结果病因肾衰竭(OR=5.041,95%CI:1.170~21.726,P=0.030)、合并低白蛋白血症(OR=2.963,95%CI:1.090~8.057,P=0.033)、躁动(OR=2.871,95%CI:1.159~7.109,P=0.023)、双下肢水肿(OR=2.359,95%CI:1.052~5.288,P=0.037)、高血压(OR=2.473,95%CI:0.010~6.057,P=0.048)、腹腔积液(OR=5.673,95%CI:2.242~14.357,P<0.001)以及输注血/血制品(OR=2.693,95%CI:1.0697~6.612,P=0.031)是儿童血液净化股静脉置管并发症的独立危险因素。预测模型ROC曲线下面积(AUC)为0.794(95%CI:0.738~0.851,P<0.001),灵敏度为0.733,特异度为0.725,最大约登指数为0.458,预测模型拟合优势比χ^(2)=3.395,P=0.907。依据验证组所建模型预测概率绘制ROC曲线,AUC为0.810(P<0.001,95%CI:0.689~0.931),灵敏度为0.739,特异度为0.778。结论本研究构建的预测模型能较好地预测儿童血液净化股静脉置管并发症的发生风险,可为医护人员早期识别高危患儿,采取有效措施预防并发症的发生提供参考。Objective To establish for the first time a risk prediction model for complications related to femoral vein catheterization for blood purification in children,and to verify the prediction performance.Methods A total of 428 children with blood purification via femoral vein in the Pediatric Nephrology Department of West China Second University Hospital in Chengdu from January 2020 to June 2022 were selected.The risk factors for complications related to femoral vein catheterization were analyzed by univariate and multivariate logistic regression,and a risk prediction model presented as a nomogram was then developed.Receiver operating characteristic(ROC)curve and calibration curve were used to assess the discrimination and calibration of the model,and a total of 50 children with femoral vein blood purification and hospitalized in the same hospital from July 2022 to October 2022 were selected to verify the model.Results Multivariate regression analysis showed that etiology of renal failure,hypoalbuminemia,dysphoria,lower extremity edema,hypertension,peritoneal effusion,infusion of blood or blood products were the risk factors for femoral vein catheter-related complications in children with blood purification.The area under the ROC curve of the model was 0.794(95%CI:0.738~0.851,P<0.001),with the sensitivity of 0.733 and the specificity of 0.725.The maximum Youden index was 0.458,with prediction model’s goodness-of-fit of χ^(2)=3.395 and P=0.907.Model verification results showed that the area under the ROC curve of the model was 0.810(95%CI:0.689~0.931,P<0.001)with the sensitivity of 0.739 and the specificity of 0.778.Conclusion This model has a satisfactory performance,and provides a reference for nurses to identify high-risk children and implement prevention care.

关 键 词：儿童 血液净化 股静脉置管 并发症 危险因素 预测模型 

分 类 号：R473[医药卫生—护理学]