维持性血液透析病人血压控制不良的影响因素分析及列线图预测模型构建  

Analysis of influencing factors of poor blood pressure control in maintenance hemodialysis patients and construction of Nomogram prediction model

作　　者：谭烂静 梁土珍 吴恒慧 林碧霞 TAN Lanjing;LIANG Tuzhen;WU Henghui;LIN Bixia(Zhanjiang First Hospital of Traditional Chinese Medicine,Guangdong 524000 China)

机构地区：[1]湛江市第一中医医院,524000

出　　处：《全科护理》2024年第24期4644-4648,共5页Chinese General Practice Nursing

摘　　要：目的:分析影响维持性血液透析(MHD)病人血压控制不良的相关因素,构建列线图预测模型并进行验证。方法:选取2020年3月—2023年2月医院收治的96例MHD病人作为研究对象,根据病人透析过程中的血压情况分为观察组(血压控制不良)19例和对照组(血压控制良好)77例。对两组病人的临床资料进行统计分析;采用Logistic回归模型分析MHD病人血压控制不良的独立危险因素;采用R软件构建MHD病人血压控制不良的列线图预测模型;采用校正曲线对预测模型进行验证;采用决策曲线分析评估预测模型的临床净收益。结果:观察组病人干体重达标率、营养状况良好率、尿素清除指数(Kt/V)≥1.2的病人占比、遵医嘱使用降压药的病人占比和降压药使用≥3种的病人占比均低于对照组(均P<0.05)。干体重不达标、营养状况不良、Kt/V<1.2、未遵医嘱使用降压药是MHD病人血压控制不良的独立危险因素(P<0.05)。模型验证结果显示,列线图预测模型的C-index为0.812[95%CI(0.545,0.986)],观测值与预测值之间保持较好的一致性。决策曲线分析显示当风险阈值>0.09时,此预测模型可以提供额外的临床净收益。结论:构建的MHD病人血压控制不良的列线图预测模型具有较好的预测价值,有助于医护人员认识MHD病人血压控制不良的危险因素并早期进行针对性护理干预,改善MHD病人的血压控制情况。Objective:To analyze the related factors of poor blood pressure control in maintenance hemodialysis(MHD)patients,and to construct a Nomogram prediction model and verify it.Methods:A total of 96 MHD patients admitted to the hospital from March 2020 to February 2023 were selected as the study objects.According to the blood pressure during dialysis,the patients were divided into observation group(poor blood pressure control,n=19)and control group(good blood pressure control,n=77).The clinical data of the two groups were statistically analyzed.Logistic regression model was used to analyze MHD patients independent risk factors for poor control of blood pressure.R software was used to construct a Nomogram model for predicting poor blood pressure control in MHD patients.The calibration curve was used to validate the prediction model.The decision curve analysis was used to evaluate the net clinical benefit of the prediction model.Results:The proportion of patients with standard dry weight,good nutritional status,Kt/V≥1.2,the proportion of patients with prescribed antihypertensive drugs and the proportion of patients with≥3 antihypertensive drugs in the observation group were lower than those in the control group(all P<0.05).Dry weight substandard,poor nutritional status,Kt/V<1.2 and non-prescribed use of antihypertensive drugs were independent risk factors for poor blood pressure control in MHD patients(P<0.05).The validation results showed that the C-index of the Nomogram prediction model was 0.812[95%CI(0.545,0.986)],which showed good consistency between the observed value and the predicted value.Decision curve analysis shows that this predictive model can provide additional net clinical benefits when the risk threshold was greater than 0.09.Conclusions:The Nomogram prediction model of MHD patients with poor blood pressure control has good predictive value,which helps medical staff to recognize the risk factors of poor blood pressure control in MHD patients and conduct targeted nursing intervention early,so as to i

关 键 词：维持性血液透析 血压 影响因素 列线图预测模型 

分 类 号：R473.5[医药卫生—护理学]