维持性血液透析患者体外循环管路凝血所致非计划性下机的Nomogram模型构建与验证  

Construction and verification of a nomogram model for unplanned disembarkation due to clotting in cardiopulmonary bypass line in patients undergoing maintenance hemodialysis

作　　者：吴海芳 徐政全[1] 沈波[1] WU Hai-fang;XU Zheng-quan;SHEN Bo(Blood Purification Center,The Second Hospital of Shaoxing,Zhejiang Province,Shaoxing 312000,China)

机构地区：[1]绍兴第二医院医共体总院血液净化中心,绍兴312000

出　　处：《中国血液净化》2024年第12期952-956,共5页Chinese Journal of Blood Purification

基　　金：浙江省医药卫生科技计划(2022KY418)。

摘　　要：目的探讨维持性血液透析患者体外循环管路凝血所致非计划性下机的影响因素,建立维持性血液透析患者体外循环管路凝血所致非计划性下机的Nomogram模型并验证。方法回顾性选取2022年4月—2023年6月在绍兴第二医院医共体总院进行治疗的维持性血液透析患者,按照7∶3的比例分为建模组和验证组。收集建模组临床资料,根据患者是否发生体外循环管路凝血分为凝血组和非凝血组。比较2组临床资料,采用多因素Logistic回归分析维持性血液透析患者体外循环管路凝血的危险因素,构建维持性血液透析患者体外循环管路凝血的Nomogram模型并进行验证。结果共纳入286例患者,其中建模组200例、验证组86例。建模组中凝血组38例、非凝血组162例,维持性血液透析患者体外循环管路凝血发生率为19%。凝血组及非凝血组在是否合并低血压(χ^(2)=4.630,P=0.031)、凝血酶原时间(t=2.392,P=0.018)、血小板计数(t=3.090,P=0.002)、是否首次接受血液透析(χ^(2)=4.935,P=0.026)、抗凝方式(χ^(2)=8.546,P=0.014)、治疗时间(χ^(2)=9.497,P=0.009)、血流速度(χ^(2)=5.194,P=0.023)、是否透析前健康教育(χ^(2)=6.991,P=0.008)等方面比较差异有统计学意义。多因素Logistic回归分析结果显示:合并低血压(OR=3.160,95%CI:1.182~8.447,P=0.022)、血小板计数(OR=1.081,95%CI:1.049~1.115,P<0.001)、是否首次接受血液透析(OR=3.354,95%CI:1.202~9.359,P=0.021)、抗凝方式为无抗凝(OR=5.845,95%CI:1.697~20.132,P=0.005)、未接受健康教育(OR=6.524,95%CI:2.322~18.330,P<0.001)是发生体外循环管路凝血的独立危险因素;凝血酶原时间长(OR=0.378,95%CI:0.261~0.547,P<0.001)、血流速度≥200 ml/min(OR=0.226,95%CI:0.081~0.625,P=0.004)是体外循环管路凝血的保护因素。对Nomogram模型进行验证,ROC曲线下面积为0.891(95%CI:0.835~0.947),区分度良好,最大约登值为0.641,灵敏度为0.789,特异度为0.852。校准曲线的理论值和�Objective To investigate the influential factors of unplanned disembarkation due to clotting in cardiopulmonary bypass line in maintenance hemodialysis(MHD)patients,and to establish a nomogram model of unplanned disembarkation due to clotting in cardiopulmonary bypass line in MHD patients and to validate the nomogram.Methods The MHD patients treated in the General Hospital of Shaoxing Second Hospital from April 2022 to June 2023 were retrospectively studied.They were divided into modeling group and validation group with the ratio of 7:3.The clinical data of the modeling group were collected and were then divided into coagulation subgroup and non-coagulation subgroup according to the presence or absence of clotting in cardiopulmonary bypass line.By comparing the clinical data of the two subgroups,multivariate logistic regression was used to analyze the risk factors for clotting in cardiopulmonary bypass line in the MHD patients,and a nomogram model of clotting in cardiopulmonary bypass line in MHD patients was established and validated.Results A total of 286 patients were recruited as the study subjects.They were divided into modeling group(n=200)and verification group(n=86)with the ratio of 7:3.The modeling group were divided into coagulation subgroup(n=38)and non-coagulation subgroup(n=162).The incidence of clotting in cardiopulmonary bypass line in MHD patients was 19%.Hypotension(χ^(2)=4.630,P=0.031),prothrombin time(t=2.392,P=0.018),platelet count(t=3.090,P=0.002),hemodialysis for the first time(χ^(2)=4.935,P=0.026),anticoagulation method(χ^(2)=8.546,P=0.014),treatment time(<8h/d,8-16h/d,>16h/d)(χ^(2)=9.497,P=0.009),blood flow velocity(<200ml/min,≥200ml/min)(χ^(2)=5.194,P=0.023)and health education before dialysis(χ^(2)=6.991,P=0.008)were statistically different between the two subgroups.Multivariate logistic regression showed that hypotension(OR=3.160,95%CI:1.182~8.447,P=0.022),platelet count(OR=1.081,95%CI:1.049~1.115,P<0.001),hemodialysis for the first time(OR=3.354,95%CI:1.202~9.359,P=0.021),no an

关 键 词：维持性血液透析 体外循环管路凝血 非计划性下机 Nomogram模型 

分 类 号：R473[医药卫生—护理学]