宫颈癌外周静脉输液性静脉炎发生风险预测模型的构建  

Construction of a risk prediction model for peripheral intravenous infusion phlebitis in cervical carcinoma

作　　者：刘莉 罗晓花 陈月梅 从丽 LIU Li;LUO Xiaohua;CHEN Yuemei;CONG Li(Infusion Room,Suqian First People's Hospital,Suqian 223800,Jiangsu Province,China;Department of Outpatient,Suqian First People's Hospital,Suqian 223800,Jiangsu Province,China;Outpatient Treatment Center,Suqian First People's Hospital,Suqian 223800,Jiangsu Province,China;Department of Oncology,Suqian First People's Hospital,Suqian 223800,Jiangsu Province,China)

机构地区：[1]宿迁市第一人民医院输液室,江苏宿迁223800 [2]宿迁市第一人民医院门诊部,江苏宿迁223800 [3]宿迁市第一人民医院门诊治疗中心,江苏宿迁223800 [4]宿迁市第一人民医院肿瘤科,江苏宿迁223800

出　　处：《医学新知》2024年第7期768-777,共10页New Medicine

基　　金：宿迁市科技计划资助项目(KY202220)。

摘　　要：目的探究宫颈癌(cervical carcinoma,CC)患者外周静脉输液性静脉炎(infusion phlebitis,IP)的危险因素,并构建外周静脉IP发生风险预测模型。方法回顾性选取2019年1月至2024年5月宿迁市第一人民医院妇产科CC患者作为研究对象,将2019年1月至2023年12月的CC患者纳入训练集,2024年1月至5月的CC患者纳入内部验证集。根据是否发生IP将患者分为IP组和非IP组。采用单因素分析和逐步Logistic回归筛选CC患者外周静脉IP发生的影响因素,并构建预测模型。采用受试者工作特征(receiver operating characteristic,ROC)曲线和ROC曲线下面积(the area under the ROC curve,AUC)、校准曲线和决策曲线评估外周静脉IP发生风险预测模型的预测效能、准确度和临床适应性。结果共纳入349例CC患者,外周静脉IP发生50例,发生率为14.33%。训练集中CC患者289例,41例发生外周静脉IP,验证集中CC患者60例,9例发生外周静脉IP。逐步多因素Logistic回归分析显示合并糖尿病、右侧穿刺、下肢穿刺、输液总量≥2000 mL是CC患者发生外周静脉IP的危险因素,而输液加温是CC患者发生外周静脉IP的保护因素。外周静脉IP发生概率P=1/[1+e^(-(1.231×糖尿病+1.075×穿刺部位+2.935×穿刺肢体+0.856×输液总量-0.983×输液加温))]。ROC分析表明模型在训练集和内部验证集的AUC(95%CI)分别为0.807(0.738,0.876)和0.838(0.719,0.956)。校准曲线提示预测概率和实际发生概率大致符合,决策曲线提示在一定阈值范围内,可使临床获益;内部验证集校准曲线和临床决策曲线效果欠佳。结论本研究构建的外周静脉IP发生风险预测模型具有一定的预测能力和临床适用性,可帮助护理人员早期识别CC患者外周静脉IP。未来仍需大样本量研究进一步验证。Objective To explore the risk factors of peripheral intravenous infusion phlebitis(IP)in cervical carcinoma(CC)patients,and construct a risk prediction model of peripheral venous IP.Methods Information of CC patients in the obstetrics and gynecology department of the First People's Hospital of Suqian city from January 2019 to May 2024 was retrospectively collected.CC patients from January 2019 to December 2023 were included in the training set,and CC patients from January 2024 to May 2024 were included in the internal validation set.Patients were divided into IP and non IP groups based on whether IP had occurred.Single factor analysis and stepwise Logistic regression were used to screen the influencing factors of peripheral venous IP in CC patients,and prediction model was constructed.The receiver operating characteristic(ROC)curve and the area under the ROC curve(AUC),calibration curve,and decision curve were used to evaluate the predictive performance,accuracy,and clinical adaptability of the risk prediction model.Results A total of 349 CC patients were included,and the incidence of peripheral venous IP was about 14.33%.In the training set,there were 289 CC patients,and peripheral venous IP occurred in 41 cases.In the validation set,there were 60 CC patients,and peripheral venous IP occurred in 9 cases.Stepwise multivariate Logistic regression analysis showed that the combination of diabetes,right puncture,lower limb puncture,and total amount of infusion≥2000 mL were risk factors for the peripheral vein IP in CC patients,while infusion heating was a protective factor for the peripheral vein IP in CC patients.Probability of peripheral venous IP=1/[1+e^(-(1.231×Diabetes+1.075×Puncture site+2.935×Puncture limb+0.856×Infusion volume-0.983×Infusion heating))].ROC analysis showed that the AUC(95%CI)of the risk prediction model for peripheral venous IP in the training set and internal validation set was 0.807(0.738,0876)and 0.838(0.719,0.956),respectively.The calibration curve indicated that the predicted proba

关 键 词：宫颈癌 外周静脉输液性静脉炎 危险因素 预测模型 

分 类 号：R473.73[医药卫生—护理学]