| 基于重症患者PICC导管堵塞影响因素建立临床预警工具 |
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| 引用本文： | 李钦领,王杨,代会,葛丽.基于重症患者PICC导管堵塞影响因素建立临床预警工具[J].中华全科医学,2022,20(10):1637-1640. |
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| 作者姓名： | 李钦领 王杨 代会 葛丽 |
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| 作者单位： | 上海交通大学医学院附属新华医院急诊医学科, 上海 200092 |
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| 基金项目： | 国家自然科学基金项目82102307上海交通大学医工交叉项目YG2021QN43 |
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| 摘 要： | 目的 分析重症患者经外周置入中心静脉导管(PICC)并发导管堵塞的危险因素，建立客观的临床预警工具。 方法 回顾性分析2011年4月—2021年4月上海交通大学医学院附属新华医院收治的458例重症患者的临床资料。采用SPSS 23.0统计学软件进行数据分析，其中计量资料组间比较采用成组t检验，计数资料组间比较采用χ2检验。采用二元logistic回归分析筛选PICC导管堵塞的独立危险因素，并采用R软件建立关于导管堵塞的临床预警工具。 结果 研究共纳入458例重症患者，其中导管堵塞组患者57例(12.4%)，非导管堵塞组患者401例(87.6%)。多因素二元logistic回归分析结果显示, 体重指数(OR=1.084, 95% CI:1.043~1.126)、PICC管留置时长(OR=1.045，95% CI:1.018~1.073)、PICC管静脉高营养(OR=3.025, 95% CI:1.305~7.014)及PICC管输血(OR=2.773, 95% CI:1.151~6.683)是导管堵塞的独立预测因子。Bootstrap法和校准曲线分析的结果显示，基于上述独立危险因素建立的导管堵塞临床预警工具的预测能力较强且稳定。 结论 重症患者PICC导管堵塞风险不容忽视，基于模型进行堵管风险的预判并为避免人为叠加堵管危险因素提供参考。
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| 关 键 词： | 重症患者 外周置入中心静脉导管 导管堵塞 危险因素 临床预警工具 |
| 收稿时间： | 2022-02-20 |
Establishment of clinical warning tool based on the influencing factors of PICC catheter occlusion in critically ill patients |
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| Affiliation: | Department of Emergency Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China |
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| Abstract: | Objective To explore the risk factors of peripherally inserted central catheter (PICC) complicated with occlusion in critically ill patients and establish a clinical warning tool. Methods Clinical data of 458 critically ill patients admitted to Xinhua Hospital from April 2011 to April 2021 were retrospectively analyzed. The software SPSS 23.0 was used to perform data analysis. The two-sample t test was applied to perform measurement data comparison and the chi-square test was used to perform count data. Binary logistic regression was applied to screen independent risk factors, and R software was used to establish a nomogram warning tool about occlusion. Results A total of 458 critically ill patients were included, of which 57 patients (12.4%) in the occlusion groups and 401 patients in the non-occlusion groups. The multivariate binary logistic regression analysis showed that the body mass index (OR=1.084, 95% CI: 1.043-1.126), PICC retention time (OR=1.045, 95% CI: 1.018-1.073), PICC intravenous nutrition (OR=3.025, 95% CI: 1.305-7.014) and PICC blood transfusion (OR=2.773, 95% CI: 1.151-6.683) were independent predictor for occlusion. In addition, the Bootstrap method and calibration curve analysis indicated that the predictive ability of the clinical warning tool for catheter occlusion based on the above independent risk factors was strong and stable. Conclusion The risk of PICC occlusion in critically ill patients cannot be ignored. Based on the tool, it could predict the risk of catheter occlusion and provide guidance for avoiding artificial superposition of risk factors. |
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