摘要
目的探讨老年经外周穿刺中心静脉置管(PICC)非住院患者发生相关性血栓的影响因素,并构建和验证预测模型。方法选取北京市大兴区人民医院2018年1月至2022年8月间老年PICC非住院患者180例,按照随机数字表法分为2组:训练集(n=105)、验证集(n=75);2组均根据置管后1个月内是否发生相关性血栓分为发生亚组与未发生亚组,比较2组临床资料;采用多因素Logistic回归分析老年PICC非住院患者发生相关性血栓的影响因素,构建与验证预测模型。结果训练集和验证集相关性血栓发生率分别为26.67%和25.33%;2组在年龄、BMI、导管内径与血管内径比、合并糖尿病、外周动脉粥样硬化、静脉血栓史、活动量减少、PICC置管维护知识掌握情况上差异有统计学意义(均P<0.05);多因素Logistic回归分析显示,年龄(OR=5.549,95%CI 1.629~18.904)、BMI(OR=4.519,95%CI 1.341~15.227)、导管内径与血管内径比(OR=7.335,95%CI 2.058~26.143)、合并糖尿病(OR=4.077,95%CI 1.511~10.998)、外周动脉粥样硬化(OR=8.404,95%CI 2.347~30.091)、静脉血栓史(OR=6.977,95%CI 1.985~24.526)、活动量减少(OR=4.111,95%CI 1.264~13.370)是老年PICC非住院患者发生相关性血栓的危险因素;掌握PICC置管维护知识(OR=0.503,95%CI 0.361~0.702)是老年PICC非住院患者发生相关性血栓的保护因素(P<0.05);根据上述因素构建的预测模型,校正曲线显示其具有较好的一致性;ROC曲线分析,该模型在训练集和验证集中预测相关性血栓的AUC分别为0.977和0.956,95%CI为(0.947~1.000)和(0.916~0.998)。结论老年PICC非住院患者相关性血栓发生风险较高,影响因素较多,根据影响因素构建的预测模型具有较好的预测价值。
Objective To explore the influencing factors for related thrombosis in elderly outpatients with peripherally inserted central catheter(PICC),and to construct and validate the predictive model.Methods A total of 180 elderly outpatients receiving PICC in Beijing Daxing District People’s Hospital from January 2018 to August 2022 were randomly divided into two groups:training set(n=105)and validation set(n=75).According to the occurrence of related thrombosis within 1 month after catheterization,these patients were divided into occurrence subgroup and the non-occurrence subgroup.The clinical data were compared between the two groups.The influencing factors for related thrombosis in elderly outpatients with PICC were analyzed using multivariate logistic regression analysis to construct and validate the predictive model.Results The incidence of thrombosis was 26.67%in the training set and 25.33%in the validation set.There were significant differences between the two groups in age,BMI,ratio of catheter diameter to vessel diameter,diabetes,peripheral atherosclerosis,history of venous thrombosis,decrease in activity,and knowledge of PICC maintenance(P<0.05).Multivariate logistic regression analysis showed that age(OR=5.549,95%CI 1.629~18.904),BMI(OR=4.519,95%CI 1.341~15.227),ratio of catheter diameter to vessel diameter(OR=7.335,95%CI 2.058~26.143),diabetes(OR=4.077,95%CI 1.511~10.998),peripheral atherosclerosis(OR=8.404,95%CI 2.347~30.091),history of venous thrombosis(OR=6.977,95%CI 1.985~24.526),and decrease in activity(OR=4.111,95%CI 1.264~13.370)were the risk factors for associated thrombosis in elderly outpatients with PICC.Mastering the knowledge of PICC maintenance(OR=0.503,95%CI 0.361~0.702)is a protective factor for the occurrence of related thrombosis in elderly outpatients with PICC(P<0.05).The prediction model constructed based on the above factors showed a good consistency in the calibration curve.ROC curve analysis demonstrated that the AUC of the model for predicting related thrombosis was 0.977 in the training set(95%CI 0.947~1.000)and 0.956 in the validation set(95%CI 0.916~0.998).Conclusion Elderly ambulatory patients with PICC are at a high risk for related thrombosis,which is associated with multiple influencing factors.The prediction model constructed based on the influencing factors has good predictive value.
作者
张鑫
张桂红
刘建立
ZHANG xin;ZHANG Gui-hong;LIU Jian-li(Clinical Laboratory of Beijing Daxing District People’s Hospital,Beijing 102600,China;Department of Emergency,China-Japan Friendship Hospital,Beijing 100029,China)
出处
《南昌大学学报（医学版）》
2023年第3期48-53,59,共7页
Journal of Nanchang University：Medical Sciences
基金
北京市卫生科技发展专项基金(2019-2-129)。
关键词
经外周穿刺中心静脉置管
非住院
相关性血栓
预测模型
老年人
peripherally inserted central catheter
ambulatory
associated thrombosis
predictive model
elderly
