儿科中心静脉通路装置相关性血栓影响因素分析及列线图预测模型构建

摘要/Abstract

摘要： 目的分析影响儿科中心静脉通路装置相关性血栓（CADVT）的因素,并构建列线图预测模型。方法回顾性分析2021年2月—2024年2月于内蒙古自治区人民医院儿科接受中心静脉穿刺置管术治疗的105例患儿临床资料,依据治疗期间是否并发CADVT将其分为血栓组、无血栓组。统计、记录入组患者临床资料,Logistic多因素回归分析法筛选影响儿科CADVT的危险因素,基于上述危险因素构建儿科CADVT风险列线图模型,拟合优度检验、受试者工作特征（ROC）曲线评价该列线图模型预测效能。结果经临床评估,105例接受中心静脉穿刺置管术治疗患儿治疗期间共30例发生CADVT,发生率约为28.57%。血栓组、无血栓组小儿危重病例评分（PCIS）评分、置管时长≥7 d、血管收缩药使用≥2种、镇静天数≥7 d比例及D二聚体（D-D）、纤维蛋白原（FIB）水平比较,差异有统计学意义（P<0.05）,性别比、年龄、身体质量指数（BMI）、置管位置、置管数量、白细胞计数（WBC）等临床资料比较,差异无统计学意义（P>0.05）。Logistic多因素回归分析赋值,结果显示,PCIS评分（OR3.408,95%CI：1.498~7.752）、置管时长≥7 d（OR=3.971,95%CI：1.746~9.033）、血管收缩药使用≥2种（OR=2.507,95%CI：1.102~5.702）、镇静天数≥7 d（OR=2.323,95%CI：1.021~5.285）、D-D（OR=3.459,95%CI：1.521~7.869）、FIB（OR=3.304,95%CI：1.452~7.515）是影响儿科CADVT发生的独立危险因素。依据上述危险因素构建的儿科CADVT风险列线图模型实测值与预测值结果基本一致,C-index指数为0.895（95%CI：0.796~0.937）。结论 PCIS评分、置管时长、血管收缩药使用情况、镇静天数、D-D、FIB是影响儿科CADVT发生的危险因素,据此构建的儿科CADVT列线图模型预测效能良好。

Abstract: Objective To analyze the factors affecting pediatric central venous access device-associated thrombosis(CADVT) and construct a nomogram prediction model. Methods The clinical data of 105 children who received central venipuncture catheters in the department of Pediatrics of the hospital from February 2021 to February 2024 were retrospectively analyzed, and they were divided into thrombus group and non-thrombus group according to whether CADVT was complicated during treatment. Clinical data of enrolled patients were collected and recorded, and the risk factors affecting pediatric CADVT were screened by Logistic multivariate regression analysis, a pediatric CADVT risk nomogram model was constructed based on the above risk factors, goodness of fit test and receiver operating characteristic (ROC) curve were used to evaluate the predictive efficacy of the nomogram model. Results According to clinical evaluation, CADVT occurred in 30 of 105 children who received central venipuncture during treatment, with an incidence of 28.57%. There were significant differences in critical case score （PCIS) score, catheterization duration ≥7 d, vasoconstrictor use ≥2 types, sedation days ≥7 d, D-dimer (D-D) and fibrinogen (FIB) levels between thrombus group and non-thrombus group （P<0.05), there were no significant differences in sex ratio, age, body mass index (BMI), placement, number of catheters and WBC （P>0.05). Logistic multivariate regression analysis assigned the following values: PCIS score (OR=3.408, 95%CI: 1.498~7.752), catheter placement duration ≥7 days (OR=3.971, 95%CI: 1.746~9.033), vasoconstrictor use ≥2 (OR=2.507, 95%CI: 1.102~5.702), sedation days ≥7 days (OR=2.323, 95%CI: 1.021~5.285), D-D (OR=3.459, 95%CI: 1.521~7.869), FIB (OR=3.304, 95%CI: 1.452~7.515) were independent risk factors for pediatric CADVT. The measured values of the pediatric CADVT risk nomogram model constructed according to the above risk factors were basically consistent with the predicted values, and the C-index was 0.895 (95%CI: 0.796~0.937). Conclusion PCIS score, catheterization duration, vasoconstrictor use, sedation days, D-D and FIB were the risk factors affecting the occurrence of pediatric CADVT, and the pediatric CADVT nomogram model constructed based on this was effective in predicting the occurrence of pediatric CADVT.

Key words: central venous access device-associated thrombus, department of pediatrics, risk factors, early warning model, predictive effectiveness

中图分类号:

R472

金小叶, 章彦雨, 李宁. 儿科中心静脉通路装置相关性血栓影响因素分析及列线图预测模型构建[J]. 中华养生保健, 2025, 43(4): 52-56.

JIN Xiao-ye, ZHANG Yan-yu, LI Ning. Analysis of Influencing Factors of Pediatric Central Venous Access Device-Associated Thrombus and Construction of Nomogram Prediction Model[J]. ZHONGHUA YANGSHENG BAOJIAN, 2025, 43(4): 52-56.

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