冠心病患者冠状动脉旁路移植术后发生压力性损伤的影响因素及其风险预测列线图模型构建  

Influencing Factors of Pressure Injury after Coronary Artery Bypass Grafting in Patients with Coronary Heart Disease and Construction of Nomogram Model for Predicting Its Risk

作　　者：张楠[1] 徐丽娜 张妍 马艳秋 法天锷[1] ZHANG Nan;XU Lina;ZHANG Yan;MA Yanqiu;FA Tiane(Nursing Department,Tianjin Chest Hospital,Tianjin 300222,China)

机构地区：[1]天津市胸科医院护理部,300222

出　　处：《实用心脑肺血管病杂志》2025年第6期11-17,共7页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：天津市护理学会2023年度立项科研课题(tjhlky2023QN07)。

摘　　要：目的分析冠心病患者冠状动脉旁路移植术后发生压力性损伤(PI)的影响因素,构建并验证其风险预测列线图模型。方法本研究为回顾性病例对照研究,采用便利抽样法选取2022年天津市胸科医院收治的行冠状动脉旁路移植术的冠心病患者2580例为研究对象。收集患者的一般资料、手术情况、术后情况,根据是否发生PI将患者分为PI组(n=271)与非PI组(n=2309)。采用LASSO回归筛选冠心病患者冠状动脉旁路移植术后发生PI可能的影响因素;采用多因素Logistic回归分析探讨冠心病患者冠状动脉旁路移植术后发生PI的影响因素;采用rms程序包建立冠心病患者冠状动脉旁路移植术后发生PI的风险预测列线图模型;采用Bootstrap法重复抽样1000次,计算一致性指数;采用Hosmer-Lemeshow拟合优度检验评价该列线图模型的拟合程度;采用ROC曲线分析该列线图模型对冠心病患者冠状动脉旁路移植术后发生PI的预测价值。结果非PI组与PI组有吸烟史者占比、有PI史者占比、NYHA分级、术前自理能力、血细胞比容、手术方式、麻醉方式、美国麻醉医师协会(ASA)评分、麻醉时间、失血量、输血量、术中平均动脉压、手术时间、血管活性药物使用剂量、皮质醇类药物使用剂量、镇静剂使用剂量比较,差异有统计学意义(P<0.05)。LASSO回归分析结果显示,PI史、ASA评分、血管活性药物使用剂量、皮质醇类药物使用剂量可能是冠心病患者冠状动脉旁路移植术后发生PI的影响因素(P<0.05)。多因素Logistic回归分析结果显示,PI史、ASA评分、血管活性药物使用剂量、皮质醇类药物使用剂量是冠心病患者冠状动脉旁路移植术后发生PI的独立影响因素(P<0.05)。基于以上因素构建冠心病患者冠状动脉旁路移植术后发生PI的风险预测列线图模型。该列线图模型的一致性指数为0.735〔95%CI(0.692~0.779)〕,且拟合程度较好(P>0.05);ROC曲�Objective To investigate the influencing factors of pressure injury(PI)after coronary artery bypass grafting in patients with coronary heart disease,and construct nomogram model for predicting its risk.Methods This study was a retrospective case-control investigation.A total of 2580 patients with coronary heart disease who underwent coronary artery bypass grafting at Tianjin Chest Hospital in 2022 were selected as the study subjects using convenience sampling method.General data,surgical detail,and postoperative outcomes of the patients were collected,and the patients were divided into PI group(n=271)and non-PI group(n=2309)according to the presence of PI.LASSO regression was used to screen for possible influencing factors of PI after coronary artery bypass grafting in patients with coronary heart disease;multivariate Logistic regression analysis was used to explore the influencing factors for PI after coronary artery bypass grafting in patients with coronary heart disease;the nomogram model for predicting the risk of PI after coronary artery bypass grafting in patients with coronary heart disease was constructed by rms program package.Bootstrap method was used to repeatedly sample 1000 times,and the consistency index was calculated.The Hosmer-Lemeshow goodness-of-fit test was used to evaluate the fitting of the nomogram model.ROC curve was drawn to analyze the predictive value of the nomogram model for PI after coronary artery bypass grafting in patients with coronary heart disease.Results There were significant differences in proportion of patients with stroke history,proportion of patients with PI history,NYHA classification,preoperative self-care capacity,hematocrit,surgical approach,anesthesia methods,American Society of Anesthesiologists(ASA)score,anesthesia duration,intraoperative blood loss,transfusion volume,mean arterial pressure during surgery,operative time,dosage of vasoactive drugs,dosage of corticosteroids,dosage of sedatives between non-PI group and PI group(P<0.05).The results of LASSO regression

关 键 词：冠心病 冠状动脉旁路移植术 压力性损伤 影响因素分析 列线图 

分 类 号：R541.4[医药卫生—心血管疾病]