MHD患者发生CAADVT的影响因素分析及风险评估模型构建
收稿日期: 2024-11-14
修回日期: 2025-09-24
录用日期: 2025-12-03
网络出版日期: 2025-12-17
基金资助
首都医科大学附属北京康复医院2021—2023年科技发展专项课题
Analysis of Influencing Factors of CAADVT in Patients Undergoing Maintenance Hemodialysis and Construction of the Risk Assessment Model
Received date: 2024-11-14
Revised date: 2025-09-24
Accepted date: 2025-12-03
Online published: 2025-12-17
目的:探讨维持性血液透析(MHD)患者发生中心静脉导管相关无症状深静脉血栓(CAADVT)的影响因素并构建风险评估模型。方法:回顾性选取2018年2月至2021年1月我院收治的326例MHD患者作为研究对象,统计分析所有患者临床资料和CAADVT发生率,采用多因素Logistic回归分析MHD患者发生CAADVT的危险因素,并构建风险评估模型。结果:本研究共纳入326例MHD患者,其中中心静脉导管相关DVT症状型10例,无症状型61例,CAADVT发生率为18.71%;采用二元Logistic分析发现,年龄>60岁、体质量指数>24 kg·m-2、糖尿病均为影响MHD患者发生CAADVT的独立危险因素(P<0.05)。本研究构建了MHD患者发生CAADVT的风险预测模型,采用Hosmer-Lemeshow检验和计算曲线下面积(AUC)发现,该模型具有较好的预测效能和拟合度。结论:年龄>60岁、体质量指数>24 kg·m-2、糖尿病均为MHD患者发生CAADVT的影响因素,临床可根据本研究的预测模型对患者进行风险评估,以便及时采取预防措施,降低DVT发生率。
马遥
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MHD患者发生CAADVT的影响因素分析及风险评估模型构建
Objective: To explore the influencing factors of central venous catheter-associated asymptomatic deep venous thrombosis (CAADVT) in patients undergoing maintenance hemodialysis (MHD) and construct the risk assessment model. Methods: A total of 326 MHD patients admitted to our hospital from February 2018 to January 2021 were retrospectively enrolled as the research objects. The clinical data and the incidence of CAADVT were statistically analyzed. The risk factors of CAADVT in MHD patients were analyzed by multivariate Logistic regression analysis, and the risk assessment model was constructed. Results: In the 326 MHD patients, there were 10 cases with symptomatic central venous catheter-associated DVT and 61 cases with CAADVT. The incidence of CAADVT was 18.71%. Binary Logistic analysis showed that age >60 years, BMI >24 kg·m-2, and diabetes mellitus were independent risk factors of CAADVT in MHD patients (P<0.05). A risk prediction model for CAADVT in MHD patients was established. By using Hosmer-Lemeshow test and calculating the area under the curve (AUC), it was found that this model had good prediction efficiency and fit degree. Conclusion: Age >60 years, BMI >24 kg·m-2 and diabetes mellitus are all influencing factors of CAADVT in MHD patients. The predictive model established in this study can be used for clinical risk assessment of patients, so that timely preventive measures can be taken to reduce the incidence of DVT.
[1] 张晓华,李静,王利华.维持性血液透析患者的长期生存分析[J].中国血液净化,2019,18(12):826-829.
[2] 于新颖,陈增焱,姜苗,等.经颈外静脉穿刺置入中心静脉导管的临床分析[J].中国小儿急救医学,2022,29(10):832-835.
[3] 王宁,郭振江,张媛媛,等.危重症患者中心静脉导管相关性血栓危险因素分析及列线图预测模型的建立[J].中华危重病急救医学,2021,33(9):1047-1051.
[4] 刘莲琴,缑楠,党羽.股静脉留置透析导管患者深静脉血栓形成的危险因素及对策[J]. 血栓与止血学,2020,26(5):843-845.
[5] 寇艳,马尹梅.小儿股静脉导管相关性深静脉血栓因素分析与护理对策[J].血栓与止血学,2022,28(3):504-506.
[6] 李巍,王莉莉,李海燕,等.急性缺血性卒中患者无症状深静脉血栓形成危险因素分析[J].中国现代神经疾病杂志,2021,21(7):592-597.
[7] 周平,王亚倩,李冰,等.胸部肿瘤手术应用不同剂量低分子肝素对凝血机制的影响[J]. 中国医师杂志,2019,21(12):1783-1786.
[8] 中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第三版)[J].中华普通外科杂志,2017,32(9):807-812.
[9] Perez-Garcia R, Alcazar-Arroyo R, de Sequera-Ortiz P. What is the role of expanded hemodialysis in renal replacement therapy in 2020?[J].Nefrología (Engl Ed), 2021,41(3):227-236.
[10] 刁宗礼,郭王,黄红东,等.2016—2020年北京市血液透析患者流行病学调查[J].医学研究杂志,2022,51(4):114-117.
[11] Liu W, He L, Zeng W, et al. Peripherally inserted central venous catheter in upper extremities leads to an increase in D-dimer and deep vein thrombosis in lower extremities[J].Thromb J, 2021,19(1):1-8.
[12] 张辉.血管内皮生长因子对老年骨折病人围手术期下肢深静脉血栓的影响[J].安徽医药, 2019, 23(7):1396-1399.
[13] 王丽丽,王金荣,高攀,等.中心静脉置入设备相关上肢深静脉血栓形成的诊断、预防和治疗[J].中国呼吸与危重监护杂志,2018,17(5):532-538.
[14] 范彬,黄芬,张玉红,等.外周静脉置入中心静脉导管(PICC)在血液疾病患者中导管相关性血流感染及血栓形成的风险分析[J].中国实验血液学杂志,2019,27(1):272-276.
[15] Jones S, Butt W, Monagle P, et al. The natural history of asymptomatic central venous catheter-related thrombosis in critically ill children[J].Blood, 2019,133(8):857-866.
[16] Östlund Å, Fläring U, Norberg Å, et al. Incidence of and risk factors for venous thrombosis in children with percutaneous non-tunnelled central venous catheters[J].Br J Anaesth, 2019,123(3):316-324.
[17] 覃燕,高文,韦义萍,等.血液透析患者发生中心静脉导管相关性深静脉血栓的危险因素[J].广西医学,2018,40(13):1410-1412,1423.
[18] 曹文娟,王珏岚,李采虹,等.老年患者经外周静脉置入中心静脉导管相关性血栓形成的危险因素研究进展[J].实用医院临床杂志,2021, 18(5):209-212.
[19] 张猛,刘刚,于广洋,等.髋关节骨折患者术前深静脉血栓形成的危险因素分析[J].局解手术学杂志,2021,30(8):708-712.
[20] 宋丹.≥60岁住院PICC置管患者深静脉血栓危险因素分析[J].国际医药卫生导报, 2022,28(4):552-555.
[21] 薛箫,林朝霞,陈俊,等.维持性血透患者股静脉留置临时中心静脉导管发生深静脉血栓138例的临床分析[J].血栓与止血学,2018,24(5):792-794, 797.
[22] Balsorano P, Virgili G, Villa G, et al. Peripherally inserted central catheter-related thrombosis rate in modern vascular access era—when insertion technique matters: a systematic review and meta-analysis[J]. J Vasc Access, 2020, 21(1): 45-54.
[23] 刘花,王咏梅,黄薇薇.上下肢深静脉血栓患者的临床特征对比[J].中国实验诊断学,2021,25(2):223-227.
[24] 韩金涛,杨莉,祁晓芳,等.急性中毒患者血液净化治疗后下肢深静脉血栓形成的高危因素分析[J].河北医药,2019,41(20):3106-3109.
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