摘要
目的探讨体外膜肺氧合(ECMO)联合应用期间连续性肾脏替代治疗(CRRT)非计划性下机的影响因素,构建预测模型并评价其效能。方法选择呼吸重症监护病房行ECMO联合CRRT治疗的45例患者,统计ECMO联合应用期间CRRT发生非计划性下机的例次,对比计划下机组和非计划性下机组指标,采用logistic回归方程构建预测模型,运用ROC曲线下面积检验模型预测效果。结果45例患者共行ECMO联合CRRT治疗343例次,其中无明确诱因的CRRT非计划性下机为212例次(61.8%),logistic回归分析显示,CRRT血流速度(OR=0.924)、ECMO血流速度(OR=1.706)及ECMO模式(OR=4.764)是ECMO联合应用期间CRRT非计划性下机的预测因子,预测模型ROC曲线下面积为0.812,灵敏度0.825,特异度0.696,最大约登指数0.521,预测模型拟合优势比χ^(2)=10.113,P=0.257。结论本预测模型效果良好,临床医务人员在ECMO联合CRRT治疗期间,可结合预测模型做好运行监测并进行针对性处理。
Objective To explore the influencing factors of unplanned failure of continuous renal replacement therapy(CRRT)during extracorporeal membrane oxygenation(ECMO),and to build a prediction model and evaluate its efficacy.Methods A total of 45 patients on CRRT during ECMO were selected.The number of unplanned failure cases of CRRT during ECMO was counted,the indexes in the planned and unplanned failure groups were compared,and logistic regression model was used to construct a prediction model,and the area under ROC curve was used to test the prediction effecacy of the model.Results The 45 patients received 343 sessions of CRRT+ECMO combination treatment,with 212 sessions(61.8%)having unplanned failure without definite inducement.Logistic regression analysis showed that CRRT blood flow velocity(OR=0.924),ECMO blood flow velocity(OR=1.706)and ECMO mode(OR=4.764)were predictors of unplanned failure of CRRT during ECMO.The area under the ROC curve of the prediction model was 0.812,the sensitivity is 0.825,the specificity was 0.696,and the maximum Youden index was 0.521,with prediction model fitting odds ratioχ2=10.113(P=0.257).Conclusion The prediction model enjoys good performance.Clinical medical workers are recommended to use the prediction model for monitoring of CRRT+ECMO combination treatment,and take targeted interventions.
作者
万娜
于洋
王淑芹
张春艳
张小建
袁庆伶
贾燕瑞
Wan Na;Yu Yang;Wang Shunqin;Zhang Chunyan;Zhang Xiaojian;Yuan Qingling;Jia Yanrui(Department of Respiratory and Critical Care Medicine,Beijing Institute of Respiratory Medicine and Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China)
出处
《护理学杂志》
CSCD
北大核心
2022年第12期6-9,共4页
Journal of Nursing Science
基金
北京市属医院科研培育计划项目(PX2018012)。
关键词
体外膜肺氧合
连续性肾脏替代治疗
非计划性下机
预测模型
extracorporeal membrane oxygenation
continuous renal replacement therapy
unplanned failure
prediction model
