中华护理杂志 ›› 2024, Vol. 59 ›› Issue (20): 2455-2462.DOI: 10.3761/j.issn.0254-1769.2024.20.004
收稿日期:
2024-01-05
出版日期:
2024-10-20
发布日期:
2024-10-28
通讯作者:
答秀维,E-mail:182181335@qq.com作者简介:
张阳阳:女,本科,主管护师,护士长,E-mail:wt2018121987@163.com
基金资助:
ZHANG Yangyang(), ZHANG Hongxin, ZHANG Na, HE Hua, DA Xiuwei(
)
Received:
2024-01-05
Online:
2024-10-20
Published:
2024-10-28
摘要:
目的 分析肝癌化疗患者完全植入式静脉输液港因并发症拔管的现状及影响因素,建立风险预测模型,并对模型进行内部验证。方法 该研究为前瞻性巢式病例对照研究,选取2021年10月—2023年9月在陕西省某三级甲等医院进行完全植入式静脉输液港维护的肝癌化疗患者作为调查对象,将其中因并发症拔管的患者纳入因并发症拔管组,按照1 ∶ 10的比例进行匹配,随机选取该时间段内计划性拔管患者作为计划性拔管组。分析肝癌化疗患者完全植入式静脉输液港因并发症拔管的原因,同时采用单因素分析和Logistic回归分析探究因并发症拔管的影响因素,建立风险预测模型及列线图,采用受试者操作特征(receiver operating characteristic,ROC)曲线、校准曲线和Hosmer-Lemeshow拟合优度检验对预测模型进行内部验证。结果 肝癌化疗患者完全植入式静脉输液港因并发症拔管的发生率为7.0%,感染(36.7%)和血栓(30.0%)是因并发症拔管的主要原因。BMI、TNM分期、是否合并糖尿病、输液港管腔数量、化疗次数是肝癌化疗患者完全植入式静脉输液港因并发症拔管的主要影响因素(P<0.05)。预测模型的ROC曲线下面积为0.871,最佳截断值为0.106,灵敏度为0.800,特异度为0.820;校准曲线的实际值与预测值间的平均绝对误差为0.011,且校准曲线接近理想曲线;Hosmer-Lemeshow拟合优度检验中,χ2=2.913(P=0.940)。结论 肝癌化疗患者完全植入式静脉输液港因并发症拔管的发生率较低,感染、血栓是其主要原因,BMI≥24、TNM分期为Ⅲ或Ⅳ期、合并糖尿病、置入双腔完全植入式静脉输液港、化疗次数>5次的患者,容易因并发症拔管。该研究构建的风险预测模型的预测效果良好,可为医护人员早期识别因并发症拔管的高风险患者提供参考。
张阳阳, 张洪新, 张娜, 何华, 答秀维. 完全植入式静脉输液港因并发症拔管风险预测模型的建立及验证[J]. 中华护理杂志, 2024, 59(20): 2455-2462.
ZHANG Yangyang, ZHANG Hongxin, ZHANG Na, HE Hua, DA Xiuwei. Construction and validation of a risk prediction model for extubation due to complications of totally implantable access port[J]. Chinese Journal of Nursing, 2024, 59(20): 2455-2462.
![]() |
表1 肝癌化疗患者完全植入式静脉输液港因并发症拔管影响因素的单因素分析结果[例(百分比,%)]
Table 1 Univariate analysis of extubation due to complications of totally implantable access port in patients with liver cancer undergoing chemotherapy[case(percentage,%)]
![]() |
![]() |
表2 肝癌化疗患者完全植入式静脉输液港因并发症拔管风险的Logistic回归分析结果
Table 2 Logistic regression of the risk for extubation due to complications of totally implantable access port in patients with liver cancer undergoing chemotherapy
![]() |
图1 肝癌化疗患者完全植入式静脉输液港因并发症拔管风险预测模型列线图 注:TIVAP为完全植入式静脉输液港。
Figure 1 Predictive nomogram for extubation due to complications of totally implantable access port in patients with liver cancer undergoing chemotherapy
图2 肝癌化疗患者完全植入式静脉输液港因并发症拔管风险预测模型的受试者操作特征曲线
Figure 2 Receiver operating characteristic curve of the prediction model for extubation due to complications of totally implantable access port in patients with liver cancer undergoing chemotherapy
图3 肝癌化疗患者完全植入式静脉输液港因并发症拔管风险预测模型的校准曲线
Figure 3 Calibration curve of the prediction model for extubation due to complications of totally implantable access port in patients with liver cancer undergoing chemotherapy
[1] | 国家卫生健康委办公厅. 原发性肝癌诊疗指南(2022年版)[J]. 中华外科杂志, 2022, 60(4):273-309. |
General Office of National Health Commission. Guidelines for diagnosis and treatment of primary liver cancer(2022 edition)[J]. Chin J Surg, 2022, 60(4):273-309. | |
[2] | 国家重大疑难疾病(原发性肝癌)中西医临床协作组. 原发性肝癌中西医结合诊疗专家共识[J]. 中医药导报, 2021, 27(9):101-107. |
National Clinical Collaboration Group of Chinese and Western Medicine for Major Difficult Diseases(Primary Liver Cancer). Consensus on diagnosis and treatment of primary liver cancer with integrated traditional Chinese and western medicine[J]. Guid J Tradit Chin Med Pharm, 2021, 27(9):101-107. | |
[3] | Moss JG, Wu O, Bodenham AR, et al. Central venous access devices for the delivery of systemic anticancer therapy(CAVA):a randomised controlled trial[J]. Lancet, 2021, 398(10298):403-415. |
[4] |
王凯蓉, 周英凤, 张晓菊, 等. 两种中心静脉输液技术的成本效果分析[J]. 中华护理杂志, 2021, 56(4):574-581.
DOI URL |
Wang KR, Zhou YF, Zhang XJ, et al. A cost-effectiveness analysis of peripherally inserted central catheter versus totally implanted venous port[J]. Chin J Nurs, 2021, 56(4):574-581.
DOI URL |
|
[5] | 马力, 刘运江, 刘荫华. 中国乳腺癌中心静脉血管通路临床实践指南(2022版)[J]. 中国实用外科杂志, 2022, 42(2):151-158. |
Ma L, Liu YJ, Liu YH. Clinical practice China guidelines on central venous vascular access for breast cancer(2022 edition)[J]. Chin J Pract Surg, 2022, 42(2):151-158. | |
[6] | Zhang JH, Ma GY, Peng S, et al. Risk factors and predictive models for peripherally inserted central catheter unplanned extubation in patients with cancer:prospective,machine learning study[J]. J Med Internet Res, 2023,25:e49016. |
[7] | Sun XW, Bai XM, Zhang Y, et al. Perioperative and postoperative complications of ultrasound-guided totally implantable venous access ports via the brachiocephalic vein in patients with cancer:a prospective study[J]. J Cancer, 2021, 12(5):1379-1385. |
[8] | 叶冬青. 巢式病例对照研究的设计及分析[J]. 疾病控制杂志, 2001, 5(1):65-68. |
Ye DQ. Design and analysis of nested case-control study[J]. Chin J Dis Contr Prev, 2001, 5(1):65-68. | |
[9] | 中心静脉通路上海协作组, 上海市抗癌协会实体肿瘤聚焦诊疗专委会血管通路专家委员会. 完全植入式输液港上海专家共识(2019)[J]. 介入放射学杂志, 2019, 28(12):1123-1128. |
Shanghai Collaborative Group on Central Venous Access,Expert Committee on Vascular Access of Solid Tumor Focus Committee of Shanghai Anti-Cancer Association. Consensus of Shanghai experts on totally implantable access port(2019)[J]. J Interv Radiol, 2019, 28(12):1123-1128. | |
[10] | Chinese Research Hospital Association Digestive Tumor Committee, Chinese Association of Upper Gastrointestinal Surgeons,Chinese Gastric Cancer Association and Gastrointestinal Surgical Group of Chinese Surgical Society Affiliated to the Chinese Medical Association. Chinese expert consensus and practice guideline of totally implantable access port for digestive tract carcinomas[J]. World J Gastroenterol, 2020, 26(25):3517-3527. |
[11] |
Bertoglio S, Cafiero F, Meszaros P, et al. PICC-PORT totally implantable vascular access device in breast cancer patients undergoing chemotherapy[J]. J Vasc Access, 2020, 21(4):460-466.
DOI PMID |
[12] |
Tsuruta S, Goto Y, Miyake H, et al. Late complications associated with totally implantable venous access port implantation via the internal jugular vein[J]. Support Care Cancer, 2020, 28(6):2761-2768.
DOI PMID |
[13] | 中国中西医结合学会外周血管疾病委员会中心静脉通路专家组. 静脉输液港植入与管理多学科专家共识(2023版)[J]. 中国普通外科杂志, 2023, 32(6):799-814. |
Expert Group of Central Venous Pathway,Committee of Peripheral Vascular Diseases, Chinese Society of Integrated Traditional Chinese and Western Medicine. Multidisciplinary expert consensus on implantation and management of venous infusion port(2023 edition)[J]. Chin J Gen Surg, 2023, 32(6):799-814. | |
[14] | 季学闻, 马利兵, 肉斯太木江·依马木, 等. 肝癌切除术后感染性并发症的危险因素及其预测模型的建立[J]. 中华医院感染学杂志, 2023, 33(4):542-546. |
Ji XW, Ma LB, Rousitaimujiang YMM, et al. Risk factors of infectious complications after hepatectomy for hepatocellular carcinoma and the construction of its predictive model[J]. Chin J Nosocomiology, 2023, 33(4):542-546. | |
[15] | 黄晓钰, 吴丽红. 肿瘤患者输液港相关性血流感染危险因素的研究进展[J]. 四川医学, 2022, 43(7):717-721. |
Huang XY, Wu LH. Research progress on risk factors of transfusion port-related bloodstream infection in tumor patients[J]. Sichuan Med J, 2022, 43(7):717-721. | |
[16] | 刘运江, 屈翔, 葛智成, 等. 乳腺癌植入式静脉输液港临床应用专家共识及技术操作指南(2017版)[J]. 中国实用外科杂志, 2017, 37(12):1377-1382. |
Liu YJ, Qu X, Ge ZC, et al. Expert consensus and technical operation guide for clinical application of implantable intravenous infusion port for breast cancer(2017 edition)[J]. Chin J Pract Surg, 2017, 37(12):1377-1382. | |
[17] |
Tiegs G, Horst AK. TNF in the liver:targeting a central player in inflammation[J]. Semin Immunopathol, 2022, 44(4):445-459.
DOI PMID |
[18] |
Hassan SA, Palaskas N, Kim P, et al. Chemotherapeutic agents and the risk of ischemia and arterial thrombosis[J]. Curr Atheroscler Rep, 2018, 20(2):10.
DOI PMID |
[19] | 陈志波, 陈钦昌, 李勇辉, 等. 身体质量指数与深静脉血栓形成因果关系的孟德尔随机化研究[J]. 中华血管外科杂志, 2019, 4(4):247-251. |
Chen ZB, Chen QC, Li YH, et al. Mendelian randomization study on the causal relationship between body mass index and deep vein thrombosis[J]. Chin J Vasc Surg, 2019, 4(4):247-251. | |
[20] |
温萌, 豆欣蔓, 苗晓琦, 等. 肿瘤患者完全植入式静脉输液港导管相关性血栓形成危险因素的Meta分析[J]. 中华护理杂志, 2022, 57(23):2825-2833.
DOI URL |
Wen M, Dou XM, Miao XQ, et al. Risk factors for catheter-related thrombosis in cancer patients with totally implantable venous access ports:a Meta-analysis[J]. Chin J Nurs, 2022, 57(23):2825-2833. | |
[21] | Salim S, Zarrouk M, Elf J, et al. Clinical implications of different risk factor profiles in patients with mesenteric venous thrombosis and systemic venous thromboembolism:a population-based study[J]. J Thromb Thrombolysis, 2019, 47(4):572-577. |
[22] |
Song X, Chen SY, Dai Y, et al. A novel incision technique of a totally implanted venous access port in the upper arm for patients with breast cancer[J]. World J Surg Oncol, 2023, 21(1):162.
DOI PMID |
[23] | Santacruz E, Mateo-Lobo R, Riveiro J, et al. Infectious complications in home parenteral nutrition:a long-term study with peripherally inserted central catheters,tunneled catheters,and ports[J]. Nutrition, 2019,58:89-93. |
[24] | Chang TC, Yen MH, Kiu KT. Incidence and risk factor for infection of totally implantable venous access port[J]. Langenbecks Arch Surg, 2022, 407(1):343-351. |
[25] |
鲁佳, 谢开红, 陈文思, 等. 肿瘤患者输液港相关性血栓预防及管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(5):544-551.
DOI URL |
Lu J, Xie KH, Chen WS, et al. Evidence summary for the prevention and management of port-related venous thromboembolism in cancer patients[J]. Chin J Nurs, 2022, 57(5):544-551.
DOI URL |
[1] | 韩冬芳, 田甜, 高畅, 张婧珺, 李小妹. 肺结核患者健康促进行为与健康心理控制源关系的混合研究[J]. 中华护理杂志, 2024, 59(9): 1029-1036. |
[2] | 司茜茜, 王莹, 赵福云, 马晓骁, 刘均娥. A型主动脉夹层患者Ⅰ期心肺康复护理方案的构建及应用[J]. 中华护理杂志, 2024, 59(9): 1037-1042. |
[3] | 沈支佳, 陈新宇, 钱志杰, 殷丽梅. 反复低血糖患者血糖管理行为退化特征的混合研究[J]. 中华护理杂志, 2024, 59(9): 1043-1050. |
[4] | 王丽梅, 李露, 李玉霞, 喻鹏, 罗倩, 张翀旎. 糖尿病周围神经病理性疼痛患者运动恐惧现状及影响因素分析[J]. 中华护理杂志, 2024, 59(9): 1051-1056. |
[5] | 丁慧敏, 戴莉敏, 蔡冬青, 杨群. 糖尿病前期患者自我管理潜在剖面分析及影响因素研究[J]. 中华护理杂志, 2024, 59(9): 1057-1064. |
[6] | 刘海婷, 王咏梅, 郑贝贝, 蔡丽丽, 叶林斌, 吴佳芸, 宁丽, 李益民, 陈为霞. 冠心病合并糖尿病患者药物素养自评量表的编制及信效度检验[J]. 中华护理杂志, 2024, 59(9): 1065-1071. |
[7] | 陈丽霞, 施慧, 朱德政, 曾莹. 成人低血糖恐惧评估工具的质量评价[J]. 中华护理杂志, 2024, 59(9): 1072-1079. |
[8] | 中国研究型医院学会过敏医学专业委员会, 中华医学会变态反应分会过敏性疾病护理学组(筹), 中华预防医学会过敏病预防与控制专业委员会, (执笔:王青 刘君 支凡 万文锦 田丰英 霍晓鹏 周文华 杨永仕 王田田 孙劲旅). 变应原特异性免疫治疗皮下注射护理的专家共识[J]. 中华护理杂志, 2024, 59(9): 1080-1083. |
[9] | 李琪, 苏晴晴, 张瑶瑶, 王田田, 吕静, 李亚可, 李海燕. 全膝关节置换患者关节遗忘变化轨迹及影响因素研究[J]. 中华护理杂志, 2024, 59(9): 1084-1090. |
[10] | 刘娅, 刘晓晴, 杨雪凝, 王平, 刘学奎, 罗丹. 结肠镜检查患者肠道准备失败风险预测模型的构建及验证[J]. 中华护理杂志, 2024, 59(9): 1091-1098. |
[11] | 孙晓晴, 张爱霞, 朱珠, 樊雪梅, 梅士娟, 黄欣欣, 丛胜楠, 谢红燕. 分娩心理创伤评估量表的编制及信效度检验[J]. 中华护理杂志, 2024, 59(9): 1099-1105. |
[12] | 谢玉生, 黄蓉蓉, 赵雪, 马蕾, 胡雁, 杨倩, 王乾沙, 明玥. 成人重度烧伤患者肠内肠外营养的证据总结[J]. 中华护理杂志, 2024, 59(9): 1106-1113. |
[13] | 李旭琴, 冯洁惠, 黄昉芳, 俞超, 梁诗雨, 王晓, 李旭芳, 朱含. 1例行机械循环辅助桥接心脏移植患者的术前护理[J]. 中华护理杂志, 2024, 59(9): 1114-1117. |
[14] | 贾晓静, 陈一竹, 许志英, 和霞, 耿超. 1例尿黑酸尿症双膝关节置换术后患者并发急性心肌梗死的护理[J]. 中华护理杂志, 2024, 59(9): 1118-1121. |
[15] | 顾培培, 曾妃, 兰美娟, 梁江淑渊, 郭璐瑶, 蔡凌云, 朱岩, 郭鸽. 肺移植患者衰弱影响因素的Meta分析[J]. 中华护理杂志, 2024, 59(9): 1122-1129. |
阅读次数 | ||||||||||||||||||||||||||||||||||||||||||||||||||
全文 34
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||
摘要 726
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||