尿毒症患者应用CRRT时体外循环装置凝血的危险因素及预警模型  

Risk factors and early warning model of coagulation with extracorporeal circulation device in uremic patients with CRRT

作　　者：孙媛 顾云雨 黄燕[1] SUN Yuan;GU Yunyu;HUANG Yan(Department of Nephrology,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,Jiangxi,China)

机构地区：[1]南昌大学第二附属医院肾脏内科,江西南昌330006

出　　处：《中国现代医生》2025年第1期38-42,共5页China Modern Doctor

摘　　要：目的探讨尿毒症患者应用连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)时体外循环装置凝血的危险因素,构建并验证风险预警模型。方法回顾性选取2020年3月至2022年3月于南昌大学第二附属医院行CRRT治疗的210例尿毒症患者作为训练集,并依据CRRT治疗过程中是否出现凝血现象将其分为凝血组和未凝血组,同时按照7∶3的比例选取2022年4月至2023年4月于本院行CRRT治疗的90例尿毒症患者作为验证集。采用单因素分析和多因素Logistic回归分析尿毒症患者应用CRRT时体外循环装置凝血的相关因素,并构建风险预测模型,采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)验证模型的预测效能。结果训练集中53例患者发生体外循环装置凝血,发生率25.24%。多因素Logistic回归分析显示,年龄≥60岁、躁动、血流量降低、血小板计数升高、跨膜压升高均是尿毒症患者应用CRRT时体外循环装置凝血的危险因素(P<0.05)。训练集的Hosmer-Lemeshow检验结果显示该模型的拟合优度较好,该模型预测尿毒症患者应用CRRT时体外循环装置凝血的曲线下面积(area under the curve,AUC)为0.956(95%CI:0.926~0.985,P<0.05),敏感度为86.40%,特异性为83.80%。验证集的拟合优度较好,预测模型的AUC为0.946(95%CI:0.915~0.977,P<0.05),敏感度为82.60%,特异性为81.80%。结论基于上述危险因素构建的风险预警模型具有较好的预测效果,可为临床识别尿毒症患者应用CRRT时体外循环装置凝血的发生及预防干预提供参考。Objective To investigate the risk factors of coagulation with extracorporeal circulation device in uremic patients with continuous renal replacement therapy(CRRT),and establish and verify the risk warning model.Methods A total of 210 uremic patients who received CRRT treatment in the Second Affiliated Hospital of Nanchang University from March 2020 to March 2022 were retrospectively selected as training set,and divided into coagulation group and non-coagulation group according to whether coagulation occurred during CRRT treatment.At the same time,90 uremic patients who underwent CRRT treatment in our hospital from April 2022 to April 2023 were selected as validation set according to the ratio of 7:3.Univariate analysis and multivariate Logistic regression were used to analyze the factors related to coagulation with extracorporeal circulation device in uremic patients with CRRT,and a risk prediction model was constructed.The receiver operating characteristic(ROC)curve was used to verify the prediction efficiency of the model.Results In training set,53 patients had coagulation with extracorporeal circulation device,the incidence was 25.24%.Multivariate Logistic regression analysis showed that age≥60 years old,agitation,decreased blood flow,elevated platelet count,and elevated transmembrane pressure were all risk factors for coagulation in patients with uremia treated with CRRT(P<0.05).The Hosmer-Lemeshow test results of the training set showed that the model had a good goodness of fitting,and area under the curve(AUC)of the model was 0.956(95%CI:0.926-0.985,P<0.05)when CRRT was applied to uremic patients,and the sensitivity was 86.40%,the specificity was 83.80%.The goodness of fitting of the validation set was good.The AUC of the prediction model was 0.946(95%CI:0.915-0.977,P<0.05),the sensitivity was 82.60%,and the specificity was 81.80%.Conclusion The risk early warning model based on the above risk factors has a good prediction effect,and can provide a reference for clinical identification of the occurrence of

关 键 词：连续性肾脏替代治疗 尿毒症 凝血 危险因素 风险预警模型 

分 类 号：R692.5[医药卫生—泌尿科学]