摘要
目的分析危重症患者中心静脉导管相关性血栓(CRT)形成的危险因素,并建立列线图预测模型。方法采用前瞻性调查研究方法,选择2018年5月至2021年3月在衡水市人民医院住院期间应用中心静脉导管的385例危重症患者作为研究对象,置管后每日行彩色多普勒超声检查至拔除导管。根据最终是否形成CRT将患者分为有血栓组和无血栓组。记录患者的性别、年龄、体质量指数(BMI)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、合并症、现患肿瘤、置管后3 d D-二聚体和右颈内静脉最大流速、机械通气时间、导管留置时间,并比较两组上述指标的差异。采用多因素Logistic回归分析影响患者CRT形成的独立危险因素,并建立列线图预测模型。采用受试者工作特征曲线(ROC曲线)、校准图形分析模型的诊断价值。结果危重症患者中心静脉CRT的发生率为16.1%(62/385)。与无血栓组比较,有血栓组APACHEⅡ评分、现患肿瘤比例、置管后3 d D-二聚体更高〔APACHEⅡ评分(分):17(15,19)比15(12,18),现患肿瘤比例:51.6%(32/62)比35.3%(114/323),置管后3 d D-二聚体(mg/L):0.84(0.64,0.94)比0.57(0.44,0.76),均P<0.05〕,置管后3 d右颈内静脉最大流速更慢〔cm/s:14(13,15)比16(14,18),P<0.05〕。单因素分析显示,APACHEⅡ评分高、现患肿瘤、置管后3 d D-二聚体高、置管后3 d右颈内静脉最大流速慢的危重症患者更易发生CRT;进一步行多因素Logistic回归分析显示,APACHEⅡ评分高、现患肿瘤、置管后3 d D-二聚体高、置管后3 d右颈内静脉最大流速慢是影响危重症患者中心静脉CRT的独立危险因素〔优势比(OR)和95%可信区间(95%CI)分别为0.876(0.801~0.957)、0.482(0.259~0.895)、0.039(0.011~0.139)、1.401(1.218~1.611),P值分别为0.003、0.021、<0.001、<0.001〕。根据多因素分析结果,构建列线图预测模型,绘制ROC曲线评价列线图的预测能力,其ROC曲线下面积(AUC)为0.820,95%CI为0.76
Objective To analyze the risk factors of central venous catheter-related thrombosis(CRT)in critically ill patients and develop the model of a nomogram.Methods A prospective investigation study was conducted on 385 critically ill patients who received central venous catheters during hospitalization in Hengshui People's Hospital from May 2018 to March 2021.Color Doppler ultrasonography was performed daily after catheterization.Patients were divided into thrombosis group and non-thrombosis group according to whether CRT was formed.The patient's gender,age,body mass index(BMI),acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,complications,existing tumor,D-dimer level on the 3rd day after catheterization,maximum velocity of right internal jugular vein on the 3rd day after catheterization,mechanical ventilation time,and catheter indwelling time were recorded,and the differences of above indexes between the two groups were compared.Multivariate Logistic regression was performed on the influencing factors with statistical differences between the two groups to establish the nomogram prediction.The receiver operator characteristic curve(ROC curve)and calibration curve were used to evaluate the predictive power of the model.Results The incidence of central venous CRT in critically ill patients was 16.1%(62/385).Compared with non-thrombosis patients,the thrombosis group patients had higher APACHEⅡscore,the proportion of existing tumor,and D-dimer level on the 3rd day after catheterization[APACHEⅡscore:17(15,19)vs.15(12,18),the proportion of existing tumor:51.6%(32/62)vs.35.3%(114/323),D-dimer(mg/L):0.84(0.64,0.94)vs.0.57(0.44,0.76),all P<0.05],the maximum flow rate of right internal jugular vein was slower on the 3rd day after catheterization[cm/s:14(13,15)vs.16(14,18),P<0.05].Univariate analysis showed that high APACHEⅡscore,critical patients with existing tumor,high D-dimer level on the 3rd day after catheterization,and slow maximum flow rate of right internal jugular vein on the 3rd day after cathet
作者
王宁
郭振江
张媛媛
王晶
郭伟
王金荣
崔朝勃
Wang Ning;Guo Zhenjiang;Zhang Yuanyuan;Wang Jing;Guo Wei;Wang Jinrong;Cui Zhaobo(Department of Respiratory and Critical Care Medicine,Hengshui People's Hospital,Hengshui 053000,Hebei,China;Department of Gastrointestinal Surgery,Hengshui People's Hospital,Hengshui 053000,Hebei,China;Department of Pharmacy,Hengshui People's Hospital,Hengshui 053000,Hebei,China;Department of Critical Care Medicine,Hengshui People's Hospital,Hengshui 053000,Hebei,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2021年第9期1047-1051,共5页
Chinese Critical Care Medicine
基金
河北省医学科研课题(20191768)
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关键词
中心静脉导管
静脉血栓
危险因素
列线图预测模型
Central venous catheter
Venous thrombosis
Risk factor
Prediction model the nomogram
