血液透析患者中心静脉导管功能不良风险预测模型的构建及验证  

Construction and validation of a risk prediction model for central venous catheter dysfunction in hemodialysis patients

作　　者：魏璐霞 李育玲[2] 孟效红[3] 张光 Wei Luxia;Li Yuling;Meng Xiaohong;Zhang Guang(School of Nursing,Shanxi Medical University,Taiyuan 030001,China;Nursing Department,the First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Neurosurgery,the First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Nephrology,the First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学护理学院,太原030001 [2]山西医科大学第一医院护理部,太原030001 [3]山西医科大学第一医院神经外科,太原030001 [4]山西医科大学第一医院肾内科,太原030001

出　　处：《中华现代护理杂志》2024年第19期2578-2585,共8页Chinese Journal of Modern Nursing

基　　金：中华医学会杂志社2022-2023年护理学科研究课题(CMAPH-NRG2022022)。

摘　　要：目的:探讨血液透析患者中心静脉导管(CVC)功能不良的危险因素,构建风险预测模型,并验证该模型的预测效果。方法:采用回顾性研究方法。采用便利抽样法,选取2021年1月—2023年8月在山西医科大学第一医院、山西省人民医院、山西省白求恩医院使用CVC进行血液透析的442例患者为研究对象;将纳入患者按照置管时间先后顺序分为建模组( n=309)和验证组( n=133)。建模组依据患者是否发生导管功能不良进行分组。采用多因素Logistic回归分析血液透析导管功能不良的影响因素,并构建风险列线图模型;采用校正曲线、受试者工作特征曲线下面积( AUC)和Hosmer-Lemeshow拟合优度检验评估模型预测效能。 结果:多因素Logistic回归分析显示,血栓史、血液高凝、置管部位、导管相关感染、导管留置时间是血液透析导管功能不良的影响因素( OR值分别为5.119、5.174、6.362、2.913、5.353,均 P<0.05),以上述5个因素为自变量构建列线图。模型内部验证结果显示,Hosmer-Lemeshow检验的χ^(2)=10.828, P=0.212;AUC为0.837(95%置信区间:0.781~0.893);校正曲线与理想曲线拟合良好。模型外部验证结果显示,Hosmer-Lemeshow检验为χ^(2)=1.944, P=0.925;AUC为0.825(95%置信区间:0.744~0.906);校正曲线与理想曲线几乎重合。 结论:本研究构建的列线图可预测血液透析患者导管功能不良发生风险,为护理人员制订相应的干预措施提供参考。Objective To explore the risk factors for central venous catheter(CVC)dysfunction in hemodialysis patients,construct a risk prediction model,and verify the model's predictive performance.Methods The retrospective research method was adopted.From January 2021 to August 2023,convenience sampling was used to select 442 patients who underwent hemodialysis by CVC at the First Hospital of Shanxi Medical University,Shanxi Provincial People's Hospital,and Shanxi Bethune Hospital as the study subjects.Patients were divided into a modeling group(n=309)and a validation group(n=133)according to the order of time of CVC.The modeling group was divided into groups based on whether patients experienced catheter dysfunction.Multivariate Logistic regression was used to analyze the influencing factors of hemodialysis catheter dysfunction and construct a nomogram model.The model's predictive performance was evaluated using the calibration curve,area under the receiver operating characteristic curve(AUC),and the Hosmer Lemeshow goodness of fit test.Results Multivariate Logistic regression analysis showed that history of thrombosis,blood hypercoagulability,catheterization site,catheter-related infection,and catheterization duration were influencing factors for catheter dysfunction in hemodialysis(OR=5.119,5.174,6.362,2.913,and 5.353;all P<0.05).The above five factors were used as independent variables to construct a nomogram.Internal validation of the model showed that the Hosmer Lemeshow test wasχ^(2)=10.828,P=0.212,and AUC was 0.837[95%confidence interval(0.781,0.893)],and the calibration curve fitted well with the ideal curve.External validation of the model indicated that the Hosmer Lemeshow test wasχ^(2)=1.944,P=0.925,and AUC was 0.825[95%confidence interval(0.744,0.906)],and the calibration curve almost coincided with the ideal curve.Conclusions The constructed nomogram can predict the risk of catheter dysfunction in hemodialysis patients and provide a reference for nursing staff to develop corresponding interventions.

关 键 词：肾透析 中心静脉导管 危险因素 预测模型 护理 

分 类 号：R473.5[医药卫生—护理学]