神经系统疾病患者膜式血浆置换发生滤器破膜的影响因素分析

doi:10.3761/j.issn.0254-1769.2021.06.005

摘要/Abstract

摘要：

目的探讨神经系统疾病患者膜式血浆置换时发生滤器破膜的影响因素,并得出滤器破膜时跨膜压的临界值。方法选取2018年1月—2020年5月某三级甲等医院神经内科ICU行膜式血浆置换的42例患者,纳入196例次血浆置换相关资料,经单因素和多因素Logistic回归分析发生滤器破膜的影响因素,并以跨膜压作为预测指标,选择2020年6月—2020年10月,35例次的血浆置换相关资料进行临床验证,分析跨膜压的最佳临界值。结果 196例次膜式血浆置换过程中,19例次（9.69%）发生滤器破膜,经Logistic回归分析显示,跨膜压（OR=1.192）是膜式血浆置换过程中滤器破膜的独立危险因素（P<0.05）。跨膜压预测滤器破膜的受试者工作特征曲线下面积为0.977,95%CI为0.952~1.000（P<0.01）,最大约登指数为0.839,跨膜压的最佳临界值为50 mmHg（1 mmHg=0.133 kPa）,灵敏度为89.5%,特异度为94.4%。验证结果发现,以跨膜压<50 mmHg为临界值,其灵敏度为100%,特异度为91.42%,准确度为91.42%。结论跨膜压对膜式血浆置换过程中发生滤器破膜的预测效果好,跨膜压维持在50 mmHg以下,能预防发生滤器破膜。

关键词: 膜式血浆置换, 滤器破膜, 跨膜压, 临界值, 护理

Abstract:

Objective To investigate the influencing factors of filter rupture in membrane-based therapeutic plasma exchange（mTPE） for neurological diseases. Methods A retrospective study was conducted to collect the clinical data of 196 cases of mTPE in 42 patients admitted to the department of Neurology in a tertiary hospital from January 2018 to May 2020. Univariate and multivariate Logistic regression analysis was conducted to analyze the risk factors for membrane rupture of the filter. Transmembrane pressure was used as a predictive indicator,and data of 35 plasma exchanges from June 2020 to October 2020 was collected for clinical verification and the best cut-off of transmembrane pressure was analyzed. Results Filter rupture occurred in 19（9.69%） cases of the 196 cases of mTPE. Logistic regression analysis showed that transmembrane pressure（OR=1.192） was an independent risk factor for filter rupture in（mTPE）（P<0.05）.The area under ROC curve（AUC） was 0.977 and 95%CI were 0.952~1.000（P<0.01）. According to the maximum Youden index value of 0.839,the optimal cut-off value of transmembrane pressure was 50 mmHg;the sensitivity was 89.5%;the specificity was 94.4%. With 50 mmHg as the cut-off value,the verification results showed that the sensitivity was 100%;the specificity was 91.42%;the accuracy was 91.42%. Conclusion The transmembrane pressure has a good predictive effect on filter rupture in mTPE. The clinical transmembrane pressure is maintained below 50 mmHg to prevent the filter rupture.

Key words: Membrane-Based Therapeutic Plasma Exchange, Filter Rupture, Transmembrane Pressure, Cut-Off Value, Nursing Care

龚立超,常红,赵洁,李苗,王召锋,魏京旭,张艳. 神经系统疾病患者膜式血浆置换发生滤器破膜的影响因素分析[J]. 中华护理杂志, 2021, 56(6): 831-835.

GONG Lichao,CHANG Hong,ZHAO Jie,LI Miao,WANG Zhaofeng,WEI Jingxu,ZHANG Yan. Study on the influencing factors of filter rupture in membrane-based therapeutic plasma exchange for neurological diseases[J]. Chinese Journal of Nursing, 2021, 56(6): 831-835.

图/表 4

表1 神经系统疾病患者膜式血浆置换时发生滤器破膜的单因素分析（n=196）

Table 1 Results of single factor analysis of filter rupture in membrane-based therapeutic plasma exchange for neurological diseases（n=196）

表2 神经系统疾病患者膜式血浆置换时发生滤器破膜的Logistic回归分析

Table 2 Results of multivariate Logistic regression analysis of filter rupture in membrane-based therapeutic plasma exchange for neurological diseases

图1 跨膜压预测滤器破膜的受试者工作特征曲线

Figure 1 ROC curve of transmembrane pressure predicting filte rupture

表3 跨膜压各界值对应的灵敏度、特异度和约登指数

Table 3 Sensitivity, specificity and Youden index of all values of transmembrane pressure

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