经外周静脉置入中心静脉导管相关深静脉血栓风险评估模型在老年住院患者中应用价值  

Application value of risk assessment model of peripherally inserted central catheter-related deep vein thrombosis in elderly hospitalized patients

作　　者：苏继源 林碧霞 陈书芳 罗彩芳 张容 张冬梅 余云华 SU Ji-yuan;LIN Bi-xia;CHEN Shu-fang;LUO Cai-fang;ZHANG Rong;ZHANG Dong-mei;YU Yun-hua(Second Cadre Ward,Fuzong Teaching Hospital of Fujian University of Traditional Chinese Medicine,The 900th Hospital of Joint Logistics Support Force,Fuzhou 350001,China)

机构地区：[1]福建中医药大学福总教学医院(联勤保障部队第九〇〇医院)干部病房二科,福建福州350001

出　　处：《临床军医杂志》2025年第2期119-123,共5页Clinical Journal of Medical Officers

基　　金：福建省自然科学基金(2023J011340);联勤保障部队第九〇〇医院院立课题基金(2023BJ01);福建医科大学启航基金(2021QH1328)。

摘　　要：目的探讨经外周静脉置入中心静脉导管相关深静脉血栓(PICC-DVT)风险评估模型在老年住院患者中的应用价值。方法选取联勤保障部队900医院干部病房二科自2019年10月至2023年8月收治的77例置入经外周静脉穿刺中心静脉导管(PICC)治疗的老年患者为研究对象。记录并比较所有患者接受PICC治疗前后实验室指标。分别于PICC治疗后第7、14、30天,采用彩色多普勒超声评估患者PICC-DVT发生情况。根据危险因素评分将患者分为低危组(分数<1分,n=50)、中危组(1分≤分数≤2分,n=23)、高危组(分数>2分,n=4)。比较3组患者PICC-DVT风险评估模型的预测发生率与实际发生率。应用受试者工作特征曲线(ROC)与Hosmer-Lemeshow拟合优度指标评估PICC-DVT风险评估模型的预测和拟合效能。采用多因素Logistic回归分析检验老年住院患者发生PICC-DVT的危险因素。结果患者接受PICC治疗前、后各项实验室指标比较,差异均无统计学意义(P>0.05)。经3次彩色多普勒超声评估,77例患者中,接受PICC治疗后共发生PICC-DVT 11例(14.29%)。中危组、高危组患者模型预测发生率与实际发生率均高于低危组,差异均有统计学意义(P<0.05);高危组患者模型预测发生率与实际发生率均高于中危组,差异均有统计学意义(P<0.05)。模型预测老年住院患者PICC-DVT发生率的ROC曲线下面积为0.823,95%可信区间0.676~0.971,P=0.029;Hosmer-Lemeshow拟合优度检验χ^(2)=2.067,P=0.559。根据是否发生血栓,将患者分为血栓组(n=11)与无血栓组(n=66)。血栓组患者静脉血栓史、慢性心功能不全比例均高于无血栓组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,慢性心功能不全、静脉血栓史均为老年住院患者发生PICC-DVT的独立危险因素(P<0.05)。结论风险评估模型对老年患者PICC-DVT发生率具有良好的预测价值。Objective To investigate the application value of the risk assessment model of peripherally inserted central catheter-related deep vein thrombosis(PICC-DVT)in elderly hospitalized patients.Methods A total of 77 elderly patients who were treated with peripherally inserted central catheter(PICC)from October 2019 to August 2023 in the Second Cadre Ward of The 900th Hospital of Joint Logistics Support Force were selected as the study objects.Laboratory indicators were recorded and compared for all patients before and after PICC treatment.At the 7th,14th and 30th day after PICC treatment,color doppler ultrasound was used to evaluate the occurrence of PICC-DVT.Patients were divided into low-risk group(score<1,n=50),medium-risk group(1≤score≤2,n=23)and high-risk group(score>2,n=4)according to risk factor scores.The predicted incidence of PICC-DVT risk assessment model was compared with the actual incidence in three groups.Receiver operating characteristic(ROC)curve and Hosmer-Lemeshow goodness of fit index were used to evaluate the prediction and fitting efficiency of PICC-DVT risk assessment model.Multivariate Logistic regression analysis was used to examine the risk factors of PICC-DVT in elderly hospitalized patients.Results There was no significant difference in laboratory indexes between patients before and after PICC treatment(P>0.05).After three color doppler ultrasound evaluation,11 cases(14.29%)of 77 patients had PICC-DVT after receiving PICC treatment.The model predicted incidence and actual incidence in middle-risk group and high-risk group were higher than those in low-risk group,and the differences were statistically significant(P<0.05).The model predicted incidence and actual incidence in high-risk group were higher than those in medium-risk group,and the differences were statistically significant(P<0.05).The area under ROC curve of the model to predict the incidence of PICC-DVT in elderly inpatients was 0.823,95%confidence interval 0.676~0.971,P=0.029.Hosmer-Lemeshow goodness of fit testχ^(2)=2.067,P

关 键 词：经外周静脉置入中心静脉导管 深静脉血栓 老年患者 风险评估模型 

分 类 号：R713.8[医药卫生—妇产科学]