股动脉穿刺介入治疗Angio-Seal血管闭合器应用并发症预测模型的构建与验证

目的探讨股动脉穿刺后采用Angio-Seal血管闭合器发生并发症的危险因素并建立预测模型,为临床护理提供参考。方法收集经股动脉入路行介入治疗、采用Angio-Seal血管闭合器的611例患者资料,行单因素和多因素Logistic回归分析并发症危险因素,建立风险预测模型进行验证。结果体重指数、低分子肝素、鞘管尺寸、活化凝血时间、制动时间是Angio-Seal血管闭合器相关并发症的独立危险因素(OR值为2.087~14.005;P<0.05,P<0.01)。ROC曲线下面积为0.864,敏感性72.7%,特异性88.2%。决策曲线分析显示预测出血风险0.02~0.81区间进行决策干预具有临床获益。结论股动脉穿刺后采用Angio-Seal血管闭合器发生并发症的独立危险因素为高体重指数、较短制动时间等5项,构建的风险预测模型效能较好,可作为相应护理的参考。

Construction and validation of a prediction model for femoral artery complications associated with the Angio-Seal arterial closure device

Objective To identify the risk factors of femoral artery complications after the use of the Angio-Seal arterial puncture closure device(APCD)and to establish a prediction model,so as to provide reference for clinical nursing.Methods A sample of 611 patients undergoing transfemoral catheterization and using Angio-Seal APCD were enrolled.The risk factors of femoral artery complications were analyzed by univariate and multivariate logistic regression,and the risk prediction model was established for verification.Results Body Mass Index,use of low-molecular-weight heparin,sheath size,activated clotting timeand immobilization time were risk factors of vascular complications occurred following Angio-Seal deployment(OR 2.087-14.005;P<0.05,P<0.01).The area under ROC curve of this model was 0.864,with the sensitivity of 72.7%and the specificity of 88.2%.Decision curve analysis showed that the prediction of bleeding risk in the range of 0.02-0.81 had clinical effect.Conclusion Risk factors of femoral artery complications using Angio-Seal APCD were high BMI and short immobilization time,etc.The risk prediction model was effective and could be used as a reference for nursing practice.