中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (10): 858-862.doi: 10.3969/j.issn.1671-4091.2025.10.014

• 血管通路 • 上一篇    下一篇

留置临时透析导管患者非计划性拔管风险预测模型的构建与验证

黄忠平    郑芳芳   

  1. 313000湖州，1湖州市第一人民医院血液透析中心
  • 收稿日期:2025-02-04 修回日期:2025-07-19 出版日期:2025-10-12 发布日期:2025-10-12
  • 通讯作者: 黄忠平 E-mail:453795961@qq.com
  • 基金资助:
    浙江省医药卫生科技计划项目(2025KY1552)

Construction and verification of a risk prediction model for unplanned extubation in patients with temporary dialysis catheter

HUANG Zhong-ping, ZHENG Fang-fang   

  1. Center of Hemodialysis, The First People's Hospital of Huzhou City, Huzhou 313000, China; ²Department of Nursing, Huanzhu Longquan Subdistrict Community Health Service Center, Huzhou 313000, China
  • Received:2025-02-04 Revised:2025-07-19 Online:2025-10-12 Published:2025-10-12
  • Contact: 313000湖州，1湖州市第一人民医院血液透析中心 E-mail:453795961@qq.com

摘要： 目的  分析留置临时透析导管患者非计划性拔管(unplanned extubation,UEX)的危险因素，构建风险预测模型，为临床早期预警提供依据。 方法  回顾性纳入湖州市第一人民医院2021年1月—2022年8月收治的临时透析导管患者，按7:3比例随机分为训练组和验证组。通过单因素及多因素Logistic回归筛选危险因素，构建预测模型并进行验证。 结果  共纳入250例患者，其中训练组175例、验证组75例。风险预测模型Y=6.392×年龄≥60+4.088×首次透析+6.679×高血压+5.749×留置≥12d。训练组的受试者工作特征曲线下面积(area under curve，AUC)为0.872(95% CI：0.813～0.931)，灵敏度为83.3%，特异度为83.5%，提示模型在训练数据中能有效区分UEX高、低风险人群；验证组的AUC为0.979(95% CI：0.934～1.000)，灵敏度为93.8%，特异度为92.6%，表明该模型在独立样本中具有优异的预测效能。 结论  年龄≥60岁、首次透析、高血压及临时置管时间≥12 d是UEX独立风险因素，基于上述危险因素构建的列线图模型可有效指导临床风险防控。

关键词: 血液透析, 临时透析导管, 非计划性拔管

Abstract: Objective  To analyze the risk factors for unplanned extubation in patients with temporary dialysis catheters and construct a risk prediction model, so as to provide a reference for early warning of unplanned extubation.  Methods  A total of 250 patients with temporary dialysis catheters admitted to Huzhou First People's Hospital from January 2021 to August 2022 were retrospectively reviewed and randomly divided into a training group and a validation group at a ratio of 7:3. Risk factors were screened by univariate and multivariate logistic regression, and a prediction model was constructed and validated.  Results  The risk prediction model was Y=6.392×age+4.088×first dialysis+6.679×hypertension+5.749×indwelling time ≥ 12 days. In the training group, the area under the receiver operating characteristic curve (AUC) was 0.872 (95% CI: 0.813～0.931), with a sensitivity of 83.3% and a specificity of 83.5%, indicating that the model can effectively distinguish high-risk and low-risk patients for unplanned extubation in the training group. In the validation group, the AUC was 0.979 (95% CI: 0.934～1.000), with a sensitivity of 93.8% and a specificity of 92.6%, indicating that the model has excellent predictive performance in independent samples.  Conclusion  Age ≥60 years, first dialysis, hypertension, and catheter indwelling time ≥ 12 days are independent risk factors for unplanned extubation. The nomogram model constructed based on the above risk factors can effectively guide the risk prevention and control.

Key words: Hemodialysis, Temporary dialysis catheter, Unplanned extubation

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