肿瘤患者PICC非计划拔管的危险因素及风险列线图模型的建立  

Establishment of risk factors and risk nomogram model for unplanned extubation during peripherally inserted central catheter retention in cancer patients

作　　者：陶雍 毛静玉 薛嵋 王丽英 李颜霞 闻萍 管振方 徐佩 周林珊 TAO Yong;MAO Jingyu;XUE Mei;WANG Liying;LI Yanxia;WEN Ping;GUAN Zhenfang;XU Pei;ZHOU Linshan(Department of Nursing,Fudan University Shanghai Cancer Center,Shanghai 200032,P.R.China)

机构地区：[1]复旦大学附属肿瘤医院护理部,复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国循证医学杂志》2025年第1期57-63,共7页Chinese Journal of Evidence-based Medicine

摘　　要：目的通过回顾性分析恶性肿瘤患者经外周置入中心静脉导管(PICC)在留置期间发生非计划拔管的危险因素,为今后有效预测非计划拔管的风险提供一定的临床依据。方法针对2016年1月至2023年6月在上海某专科肿瘤医院血管通路护理中心进行PICC置管、导管维护并最后拔管的27998例肿瘤患者进行回顾性分析,收集患者一般资料、置管信息、维护信息等。单因素分析采用卡方检验,多因素分析采用二分类非条件logistic回归法。按照7∶3的比例随机分为建模组和内部验证组,建立相关列线图的预测模型,并进行内部验证。结果肿瘤患者PICC留置期间非计划拔管的发生率为2.80%(784/27998例),单因素分析显示:年龄、性别、诊断、导管留置时间、导管脱出、导管相关感染、导管相关性血栓、继发性异位、皮炎、堵管对非计划拔管有影响(P<0.05)。年龄、诊断、导管留置时间、导管脱出、导管相关感染、导管相关性血栓、继发性异位、堵管为非计划拔管的独立危险因素(P<0.05)。基于上述8项独立危险因素,建立预测肿瘤患者PICC留置期间非计划拔管发生风险的列线图模型,预测列线图的ROC曲线下面积在建模组为0.9[95%CI(0.89,0.92)],校准曲线显示模型表现出较好的预测符合度。内部验证显示预测模型ROC曲线下面积为0.91[95%CI(0.89,0.94)],预测曲线趋势接近于标准曲线。结论年龄≥60岁、非胸部肿瘤患者、导管留置时间(≤6个月)、导管脱出、导管相关感染、导管相关性血栓、继发性异位、堵管会增加非计划拔管的风险。本研究建立的列线图模型有良好的预测能力及区分度,利于临床筛查不同程度的风险患者,以及时做好有针对性的预防和有效的处理措施,最终降低非计划拔管的发生。Objective To retrospectively analyze the causes and risk factors of unplanned extubation(UE)in cancer patients during peripherally inserted central catheter(PICC)retention,so as to provide references for effectively predicting the occurrence of UE.Methods 27998 cancer patients who underwent PICC insertion,maintenance and removal in the vascular access nursing center of our hospital from January 2016 to June 2023 were retrospectively analyzed.General information,catheterization information,and maintenance information were collected.The Chisquared test was used for univariate analysis,multivariate analysis was used by binary unconditional logistic regression.They were randomly divided into modeling group and internal validation group according to the ratio of 7∶3.The related nomogram prediction model and internal validation were established.Results The incidence of UE during PICC retention in tumor patients was 2.80%(784/27998 cases).Univariate analysis showed that age,gender,diagnosis,catheter retention time,catheter slipping,catheter related infection,catheter related thrombosis,secondary catheter misplacement,dermatitis,and catheter blockage had an impact on UE(P<0.05).Age,diagnosis,catheter retention time,catheter slipping,catheter related infection,catheter related thrombosis,secondary catheter misplacement,and catheter blockage are independent risk factors for UE(P<0.05).Based on the above 8 independent risk factors,a nomogram model was established to predict the risk of UE during PICC retention in tumor patients.The ROC area under the predicted nomogram was 0.90(95%CI 0.89 to 0.92)in the modeling group,and the calibration curve showed good predictive consistency.Internal validation showed that the area under the ROC curve of the prediction model was 0.91(95%CI 0.89 to 0.94),and the trend of the prediction curve was close to the standard curve.Conclusion Patients aged≥60 years,non chest tumor patients,catheter retention time(≤6 months),catheter slipping,catheter related infections,catheter related throm

关 键 词：外周置入中心静脉导管(PICC) 非计划拔管 危险因素 风险列线图模型 

分 类 号：R473.73[医药卫生—护理学]