早产儿经上肢置入PICC尖端继发性异位风险预测模型的建立与验证

doi:10.3761/j.issn.0254-1769.2026.09.004

摘要/Abstract

摘要：

目的建立早产儿经上肢置入PICC尖端继发性异位风险预测模型并评价其预测效能，旨在为继发性异位的预防提供参考。方法回顾性收集2022年1月—2025年4月于内蒙古自治区某三级甲等医院新生儿重症监护室住院的216例早产儿的临床资料，采用单因素分析及Logistic回归分析探究早产儿经上肢置入PICC尖端继发性异位的危险因素，建立风险预测模型，并绘制列线图。采用受试者操作特征曲线、校准曲线和Hosmer-Lemeshow拟合优度检验对预测模型进行内部验证。结果早产儿经上肢置入PICC尖端继发性异位的发生率为12.0%。Logistic回归分析结果显示，置管部位、有无喂养中断或喂养量减少、置管时导管尖端位置、体重增长速率是早产儿经上肢置入PICC尖端继发性异位的影响因素（均P<0.05）。预测模型的受试者操作特征曲线下面积为0.836，95%CI为0.713~0.958，灵敏度为0.867，特异度为0.684；校准曲线接近理想曲线；Hosmer-Lemeshow拟合优度检验结果显示，χ²=6.234、P=0.435。结论该研究构建的早产儿经上肢置入PICC尖端继发性异位风险预测模型具有较好的预测效能，可为新生儿科护士早期识别继发性异位高风险早产儿、及时采取个性化预防措施提供参考。

关键词: 早产儿, 经外周置入中心静脉导管, 继发性异位, 预测模型, 列线图, 儿科护理学

Abstract:

Objective To analyze the status and influencing factors of secondary tip malposition of PICC in the upper extremity of preterm infants，to establish a risk prediction model，and to conduct internal validation of the model. Methods A total of 216 preterm infants who were hospitalized in the neonatal intensive care unit in Inner Mongolia from January 2022 to April 2025 were retrospectively collected. A comprehensive data set pertaining to secondary PICC tip malposition in upper extremity in preterm infants was meticulously compiled. Univariate analysis and Logistic regression ananlysis were used to explore the influencing factors of secondary PICC tip malposition in the upper extremity of preterm infants. A visual nomogram risk prediction model was established，and the model was internally verified by receiver operating characteristic（ROC） curve and Hosmer-Lemeshow fit test. Results The incidence of secondary PICC tip malposition was 12.0%. The site of tube placement，feeding interruption or reduction in milk intake，the catheter tip position，the rate of weight gain were the main influencing factors of secondary PICC tip malposition（P<0.05）. The area under ROC curve of the prediction model was 0.836（95%CI 0.731~0.958），the sensitivity was 0.867，and the specificity was 0.684.The calibration curve was close to the ideal curve. The Hosmer-Lemeshow goodness of fit test was χ²=6.234（P=0.435）. Conclusion A predictive model for secondary PICC tip malposition in the upper extremity of preterm infants has been constructed on the basis of the site of catheter placement，the presence of feeding interruption or milk reduction，the location of the catheter tip，and the rate of weight gain. This model demonstrates good predictive ability and can provide guidance for clinical diagnosis and treatment.

Key words: Preterm Infant, Peripherally Inserted Central Catheter, Malposition, Prediction Model, Nomogram, Pediatric Nursing

李佳, 张玉玲, 邢乐, 张利峰, 牛秀峰, 许莉. 早产儿经上肢置入PICC尖端继发性异位风险预测模型的建立与验证[J]. 中华护理杂志, 2026, 61(9): 1180-1186.

LI Jia, ZHANG Yuling, XING Le, ZHANG Lifeng, NIU Xiufeng, XU Li. Construction and validation of a risk prediction model for secondary peripherally inserted central catheter tip malposition in the upper extremity of preterm infants[J]. Chinese Journal of Nursing, 2026, 61(9): 1180-1186.

图/表 4

表1 早产儿的一般资料及经上肢置入PICC尖端继发性异位的单因素分析结果

Table 1 General characteristics and univariate ananlysis results of secondary tip malposition of PICC in the upper extremity of preterm infants

表2 早产儿经上肢置入PICC尖端继发性异位的Logistic回归分析结果（n=216）

Table 2 Logistic regression of the risk for secondary tip malposition of PICC in the upper extremity of preterm infants（n=216）

图1 早产儿经上肢置入PICC尖端继发性异位风险预测模型列线图

Figure 1 Predictive nomogram for secondary tip malposition of PICC in the upper extremity of preterm infants

图2 早产儿经上肢置入PICC尖端继发性异位风险模型的受试者操作特征曲线

Figure 2 Receiver operator characteristic curve of the prediction model for secondary tip malposition of PICC in the upper extremity of preterm infants

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