新生儿外周留置针穿刺点渗血风险预测模型的构建及验证  

Construction and validation of a risk prediction model for bleeding at the puncture site of peripheral indwelling needles in neonates

作　　者：郁晓曼 吴倩[1] 赵洋[1] 陈蕾[2] 毕雯[1] 于珊珊[1] YU Xiaoman;WU Qian;ZHAO Yang;CHEN Lei;BI Wen;YU Shanshan(Department of Neonatology,Affiliated Hospital of Qingdao University,Qingdao 266001,China;Department of Nursing and Hospital-Acquired Infection Control,Affiliated Hospital of Qingdao University,Qingdao 266001,China)

机构地区：[1]青岛大学附属医院新生儿科,青岛市266001 [2]青岛大学附属医院护理院感处,青岛市266001

出　　处：《护理管理杂志》2024年第9期785-789,共5页Journal of Nursing Administration

摘　　要：目的构建新生儿外周留置针穿刺点渗血风险预测模型,并验证其预测效果。方法采用便利抽样法,选取2022年3月至12月青岛市某三级甲等医院新生儿科收治的168例新生儿作为研究对象,根据穿刺点有无渗血分为渗血组和未渗血组。采用Logistic回归分析建立风险预测模型。采用Hosmer-Lemeshow检验、受试者工作特征曲线评价模型的拟合优度及预测效果,另选取55例新生儿对模型进行外部验证。结果建模组168例新生儿中,73例发生留置针穿刺点渗血,发生率为43.45%。穿刺位置、针座与血管方向是否处于同一水平面、是否二次固定、透明敷料是否松脱、是否输注高渗性药物和是否处于镇静状态是新生儿外周留置针穿刺点渗血的影响因素(P<0.05)。ROC曲线下面积为0.779,灵敏度为0.740,特异度为0.705。结论穿刺位置位于关节部位、透明敷料松脱、输注高渗性药物是新生儿外周留置针穿刺点渗血的独立危险因素,针座与血管方向处于同一水平面、二次固定、新生儿处于镇静状态为保护性因素。基于此构建的新生儿外周留置针穿刺点渗血风险预测模型具有良好的预测效能,为临床医护人员进行预见性护理提供决策依据。Objective To establish a risk prediction model for bleeding at the puncture site of peripheral indwelling needles in neonates and verify its prediction effect.Methods From March 2022 to December 2022,168 newborns in the neonatal department of a grade A class three hospital in Qingdao were selected as the research object,and the newborn were divided into two groups according to the presence or absence of bleeding at the puncture point.Logistic regression analysis was used to establish a risk prediction model.Hosmer-Lemeshow test and receiver operating characteristic curve were used to evaluate the goodness of fit and prediction effect of the model.Another 55 newborns were selected for external verification of the model.Results Among the 168 newborns in the modeling group,73 had bleeding at the puncture point of the indwelling needle,with an incidence of 43.45%.The puncture site,whether the needle seat and the blood vessel ware at the same level,whether there was secondary fixation,whether the transparent dressing was loose,whether the hyperosmotic drug was infused,and whether the patient was in a sedated state were the influence factors of bleeding at the puncture site of the neonatal peripheral indwelling needle(P<0.05).The area under ROC curve(AUC)was 0.779,the sensitivity was 0.740 and the specificity was 0.705.Conclusion The puncture site at the joint,loosening of transparent dressing and infusion of hyperosmotic drugs are independent risk factors for bleeding at the puncture site of the neonatal peripheral indwelling needle.The needle seat and the blood vessel being at the same level,secondary fixation,and the neonate being in a sedated state are protective factors.The risk prediction model for bleeding at the puncture site of the neonatal peripheral indwelling needle constructed based on this has good prediction efficiency,and can provide decision-making basis for clinical medical staff to carry out predictive care.

关 键 词：新生儿 留置针 渗血 护理 影响因素 预测模型 

分 类 号：R452[医药卫生—治疗学] R473.72[医药卫生—临床医学]