危重症病人双腔中心静脉导管功能障碍风险预测模型的构建与验证  

Construction and validation of a risk prediction model for double-lumen central venous catheter dysfunction in critically ill patients

作　　者：贾秀芬 刘玉平 高晶 陈翠 张娟 蒋丽 张艳丹 张娟娟 张杰 JIA Xiufen;LIU Yuping;GAO Jing;CHEN Cui;ZHANG Juan;JIANG Li;ZHANG Yandan;ZHANG Juanjuan;ZHANG Jie(The Affiliated Hospital of Xuzhou Medical University,Jiangsu 221000 China)

机构地区：[1]徐州医科大学附属医院,221000

出　　处：《全科护理》2025年第4期714-719,共6页Chinese General Practice Nursing

基　　金：中华护理杂志社2023年静脉治疗护理专项科研项目,编号:ZHHLZZS-202322;徐州市科技局2023年度医药卫生面上项目,编号:KC23282。

摘　　要：目的:构建危重症病人双腔中心静脉导管功能障碍风险预测模型并进行验证。方法:采用便利抽样法选取2023年12月—2024年3月某三级甲等医院重症医学科留置双腔中心静脉导管的635例病人作为调查对象,收集病人的临床资料,每日常规评估导管功能;采用单因素分析、Logistic回归分析筛选危重症病人双腔中心静脉导管发生功能障碍的影响因素,据此构建危重症病人双腔中心静脉导管功能障碍风险预测模型,采用Hosmer-Lemeshow检验及受试者工作特征(ROC)曲线下面积(AUC)评价模型的拟合和预测效果。结果:危重症病人双腔中心静脉导管功能障碍发生率为38.97%;Logistic回归分析结果显示,COPD[OR=3.336,95%CI(1.359,8.337),P<0.05]、D-二聚体浓度[OR=1.125,95%CI(1.077,1.175),P<0.001]和冲封管不当[OR=1.784,95%CI(1.091,2.918),P<0.05]是危重症病人双腔中心静脉导管发生功能障碍的独立危险因素;Hosmer-Lemeshow检验结果显示χ^(2)=14.097,P=0.079,AUC为0.735[95%CI(0.686,0.784),P<0.001],最佳临界值为0.375,灵敏度为0.569,特异度为0.806。验证结果显示,模型的灵敏度为0.632,特异度为0.736,正确率为80.90%。结论:危重症病人双腔中心静脉导管功能障碍风险预测模型条目少,预测效能良好,可为临床快速筛查导管功能障碍高风险病人提供参考。Objective:To construct and validate a risk prediction model for dysfunction of double-lumen central venous catheters in critically ill patients.Methods:A convenience sampling method was used to select 635 patients with double-lumen central venous catheters in the intensive care unit of a tertiary hospital from December 2023 to March 2024.Clinical data were collected,and catheter function was routinely assessed daily.Univariate analysis and Logistic regression analysis were used to identify influencing factors for catheter dysfunction in critically ill patients.Based on these factors,a risk prediction model for catheter dysfunction was constructed.The Hosmer-Lemeshow test and the area under the receiver operating characteristic(ROC) curve(AUC) were used to evaluate the model's fit and predictive performance.Results:The incidence of double-lumen central venous catheter dysfunction in critically ill patients was 38.97%.Logistic regression analysis revealed that COPD[OR=3.336,95%CI(1.359,8.337),P<0.05],D-dimer concentration[OR=1.125,95%CI(1.077,1.175),P<0.001],and improper flushing and sealing of the catheter [OR=1.784,95%CI(1.091,2.918),P<0.05] were independent risk factors for catheter dysfunction.The Hosmer-Lemeshow test showed χ^(2)=14.097,P=0.079,and AUC was 0.735[95%CI(0.686,0.784),P<0.001],the optimal critical value was 0.375,the sensitivity was 0.569 and the specificity was 0.806.The results of validation showed that the sensitivity was 0.632,the specificity was 0.736,and the accuracy rate was 80.90%.Conclusion:The risk prediction model for double-lumen central venous catheter dysfunction in critically ill patients has a small number of items and good predictive performance,providing a reference for the rapid clinical screening of high-risk patients for catheter dysfunction.

关 键 词：双腔中心静脉导管 功能障碍 风险模型 危险因素 危重症病人 护理 

分 类 号：R47[医药卫生—护理学]