住院患儿静脉血栓栓塞症风险预测模型的构建及验证

doi:10.3761/j.issn.0254-1769.2024.16.007

摘要/Abstract

摘要：

目的构建住院患儿静脉血栓栓塞症（venous thromboembolism，VTE）风险预测模型，并验证模型的预测效果。方法回顾性选取2022年1月—2023年7月在武汉市某三级甲等儿童专科医院住院且发生VTE的62例患儿作为VTE组，按照1 ∶ 4的比例选择同时间段在同科室住院且未发生VTE的248例患儿作为非VTE组，采用Logistic回归分析建立风险预测模型，采用Hosmer-Lemeshow检验和受试者操作特征（receiver operator characteristic，ROC）曲线分别检验模型的拟合优度及预测效果，采用Bootstrap自助法重抽样1 000次对模型进行内部验证。结果研究期间，VTE发生率为0.43‰。Logistic回归分析显示，PICC留置时长≥3 d、留置完全植入式静脉输液港、化疗、ICU住院时长≥4 d、制动时长>72 h是住院患儿发生VTE的独立危险因素（P<0.05）。Hosmer-Lemeshow检验结果显示，χ²=5.291，P=0.152。Bootstrap自助法重抽样结果显示，模型的灵敏度为0.857，特异度为0.218，ROC曲线下面积为0.823。结论该研究构建的住院患儿VTE风险预测模型具有良好的预测效能，可为护理人员早期识别VTE高风险患儿、及时采取预防措施提供依据。

关键词: 静脉血栓栓塞症, 危险因素, 预测模型, 儿科护理学

Abstract:

Objective To establish a risk prediction model for the occurrence of venous thromboembolism（VTE） in hospitalized children and to validate the application of the model. Methods Retrospective analysis was conducted on 62 children who developed VTE during hospitalization in our hospital from January 2022 to July 2023 and were selected in a VTE group. In the ratio of 1：4，248 children from the same department and time who did not develop VTE were selected in a non-VTE group. Logistic regression analysis was used to develop the risk prediction model. Hosmer-Lemeshow test and receiver operator characteristic（ROC） curves were used to test the goodness of fit and predictive effectiveness of the model. Bootstrap self-help method was used for the internal validation of the model by re-sampling the sample 1，000 times. Results In our study，the incidence of VTE was 0.43‰. Logistic regression analysis showed that the length of central venous access device（PICC） stay ≥3 d，stay with fully implantable intravenous port，chemotherapy，ICU length of stay ≥4 d，and bracing duration >72 h were the independent risk factors for the development of VTE in hospitalized children（P<0.05）. Hosmer-Lemeshow test showed that χ²=5.291，P=0.152. Sensitivity was 0.857，specificity was 0.218，and area under the ROC curve was 0.823 by Bootstrap self-help method resampling method. Conclusion The risk predictive model of VTE risk in hospitalized children constructed in this study has good predictive performance，which can be used for clinical medical staff to identify children at high risk of VTE at an early stage and take preventive measures.

Key words: Venous Thromboembolism, Risk Factors, Prediction Model, Pediatric Nursing

陈娅娟, 周蕊, 孙丹, 刘新文. 住院患儿静脉血栓栓塞症风险预测模型的构建及验证[J]. 中华护理杂志, 2024, 59(16): 1966-1972.

CHEN Yajuan, ZHOU Rui, SUN Dan, LIU Xinwen. Construction and validation of a risk prediction model for venous thromboembolism in hospitalized children[J]. Chinese Journal of Nursing, 2024, 59(16): 1966-1972.

图/表 4

表1 调查对象的一般资料及静脉血栓栓塞症危险因素的单因素分析结果[例（百分比，%）]

Table 1 General information of survey subjects and the result of single factor analysis of VTE in hospitalized children[case（percentage，%）]

表2 住院患儿静脉血栓栓塞症危险因素的Logistic回归分析结果（n=310）

Table 2 Logistic regression analysis of risk factors for VTE in hospitalized children（n=310）

图1 住院患儿静脉血栓栓塞症风险预测模型列线图

Figure 1 A nomogram model for predicting VTE in hospitalized children

图2 住院患儿静脉血栓栓塞症风险预测模型的受试者操作特征曲线

Figure 2 Receiver operating characteristic curve of the risk prediction model for VTE in hospitalized children

参考文献 26

[1]	李辉, 姜格宁. 胸部恶性肿瘤围术期静脉血栓栓塞症预防中国专家共识(2018版)[J]. 中国肺癌杂志, 2018, 21(10):739-752.
	Li H, Jiang GN. Perioperative venous thromboembolism(VTE) prophalaxis in thoracic cancer patients:Chinese expert consensus[J]. Chin J Lung Cancer, 2018, 21(10):739-752.
[2]	杜思泓. 儿童深静脉血栓的临床特征及危险因素研究[D]. 重庆: 重庆医科大学, 2018.
	Du SH. Clinical characteristics and risk factors of deep venous thrombosis in children[D]. Chongqing: Chongqing Medical University, 2018.
[3]	Biss TT. Venous thromboembolism in children:is it preventable?[J]. Semin Thromb Hemost, 2016, 42(6):603-611.
[4]	Han H, Hensch L, Hui SKR, et al. Evaluation and management of coagulopathies and thrombophilias in pediatric patients[J]. Clin Lab Med, 2021, 41(1):83-100. DOI PMID
[5]	李海燕, 李蓉, 植艳茹, 等. 中老年患者院内发生静脉血栓栓塞症风险预测模型的研究[J]. 中华护理杂志, 2020, 55(1):68-73. DOI
	Li HY, Li R, Zhi YR, et al. Study on risk prediction model of in-hospital venous thromboembolism in middle-aged and elderly patients[J]. Chin J Nurs, 2020, 55(1):68-73. DOI
[6]	蒋伟红, 金陈娣, 李帅妮, 等. 先天性心脏病术后患儿中心静脉导管相关深静脉血栓风险预测模型的构建及验证[J]. 中华护理杂志, 2022, 57(18):2217-2224.
	Jiang WH, Jin CD, Li SN, et al. Construction and validation of a risk prediction model for central venous catheter-associated deep venous thromboses in children with congenital heart disease after surgery[J]. Chin J Nurs, 2022, 57(18):2217-2224.
[7]	Kerlin BA, Stephens JA, Hogan MJ, et al. Development of a pediatric-specific clinical probability tool for diagnosis of venous thromboembolism:a feasibility study[J]. Pediatr Res, 2015, 77(3):463-471. DOI PMID
[8]	田凌云, 王丽倩, 曾佳琪, 等. 儿童静脉血栓栓塞症风险评估模型的研究进展[J]. 中华护理杂志, 2020, 55(3):462-467. DOI
	Tian LY, Wang LQ, Zeng JQ, et al. Research progress on risk assessment models for venous thromboembolism in children[J]. Chin J Nurs, 2020, 55(3):462-467.
[9]	Riley RD, Ensor J, Snell KIE, et al. Calculating the sample size required for developing a clinical prediction model[J]. BMJ, 2020,368:m441.
[10]	国家卫生健康委员会. 7岁以下儿童生长标准(WS/T 423-2022)[EB/OL]. (2022-09-19)[2023-10-07]. http://www.nhc.gov.cn/wjw/fyjk/202211/16d8b049fdf547978a910911c19bf389/files/87dabebc66e1421b903f20c5db53ac07.pdf.
	National Health Commission of the People’s Republic of China. Health industry standard of the People’s Republic of China growth standard for children under 7 years old(WS/T 423-2022)[EB/OL]. (2022-09-19)[2023-10-07]. http://www.nhc.gov.cn/wjw/fyjk/202211/16d8b049fdf547978a910911c19bf389/files/87dabebc66e1421b903f20c5db53ac07.pdf.
[11]	中国营养学会. 中国居民膳食指南[M]. 北京: 人民卫生出版社, 2016.
	Chinese Nutrition Society. Dietary guide for China residents[M]. Beijing: People’s Medical Publishing House, 2016.
[12]	国家卫生健康委员会. 医疗机构手术分级管理办法[EB/OL].(2022-12-19)[2023-10-07]. http://www.nhc.gov.cn/yzygj/s7657/202212/5eb7ddbaa8004a4497c5f29d3a2a5b4d.shtml.
	National Health Commission of the People’s Republic of China. Management measures for surgical grading in medical institutions[EB/OL]. (2022-12-19)[2023-10-07]. http://www.nhc.gov.cn/yzygj/s7657/202212/5eb7ddbaa8004a4497c5f29d3a2a5b4d.shtml.
[13]	杜思泓, 苏庸春, 李颖, 等. 儿童静脉血栓的临床特征及危险因素分析[J]. 儿科药学杂志, 2019, 25(4):14-17.
	Du SH, Su YC, Li Y, et al. Clinical characteristics and risk factors of venous thrombosis in children[J]. J Pediatr Pharm, 2019, 25(4):14-17.
[14]	邵翔, 翟振国, 王辰. 医院相关性静脉血栓栓塞症[J]. 中华医学杂志, 2018, 98(46):3792-3794.
	Shao X, Zhai ZG, Wang C. Hospital associated venous thromboembolism[J]. Natl Med J Chin, 2018, 98(46):3792-3794.
[15]	樊晓乐, 赵辉. 急性下肢深静脉血栓形成介入治疗研究进展[J]. 介入放射学杂志, 2019, 28(1):98-101.
	Fan XL, Zhao H. Interventional treatment for acute deep venous thrombosis of lower extremity:recent progress in research[J]. J Interv Radiol, 2019, 28(1):98-101.
[16]	Menéndez JJ, Verdú C, Calderón B, et al. Incidence and risk factors of superficial and deep vein thrombosis associated with peripherally inserted central catheters in children[J]. J Thromb Haemost, 2016, 14(11):2158-2168. DOI PMID
[17]	Taxbro K, Hammarskjöld F, Thelin B, et al. Clinical impact of peripherally inserted central catheters vs implanted port catheters in patients with cancer:an open-label,randomised,two-centre trial[J]. Br J Anaesth, 2019, 122(6):734-741. DOI PMID
[18]	郭宏溪, 卞红强, 彭飞. 完全植入式静脉输液港与经外周静脉穿刺中心静脉置管在儿童化疗中的个体化选择[J]. 现代肿瘤医学, 2022, 30(16):2986-2990.
	Guo HX, Bian HQ, Peng F. Individualized selection of totally implantable vein port and peripheral inserted central catheter in children’s chemtherapy[J]. J Mod Oncol, 2022, 30(16):2986-2990.
[19]	Noonan PJ, Hanson SJ, Simpson PM, et al. Comparison of complication rates of central venous catheters versus peripherally inserted central venous catheters in pediatric patients[J]. Pediatr Crit Care Med, 2018, 19(12):1097-1105.
[20]	Dadashzadeh ER, Bou-Samra P, Huckaby LV, et al. Leveraging decision curve analysis to improve clinical application of surgical risk calculators[J]. J Surg Res, 2021,261:58-66.
[21]	Khorana AA. Venous thromboembolism prevention in cancer outpatients[J]. J Natl Compr Cancer Netw, 2013, 11(11):1431-1438.
[22]	Kashanian SM, Holtzman NG, Patzke CL, et al. Venous thromboembolism incidence and risk factors in adults with acute lymphoblastic leukemia treated with and without pegylated E. coli asparaginase-containing regimens[J]. Cancer Chemother Pharmacol, 2021, 87(6):817-826.
[23]	Connelly CR, Laird A, Barton JS, et al. A clinical tool for the prediction of venous thromboembolism in pediatric trauma patients[J]. JAMA Surg, 2016, 151(1):50-57. DOI PMID
[24]	张晶晶, 江智霞, 吴华炼, 等. ICU静脉血栓栓塞症风险因素的Meta分析[J]. 重庆医学, 2017, 46(9):1230-1234.
	Zhang JJ, Jiang ZX, Wu HL, et al. Risk factors of venous thromboembolism in ICU:a meta-analysis[J]. Chongqing Med, 2017, 46(9):1230-1234.
[25]	Kobayashi T, Akiyama T, Mawatari M. Predictors of preoperative deep vein thrombosis in hip fractures:a systematic review and meta-analysis[J]. J Orthop Sci, 2023, 28(1):222-232.
[26]	韩汝宁, 李秀川, 赵士兵, 等. ICU患者早期康复方案的构建及应用研究[J]. 中华护理杂志, 2020, 55(1):8-15. DOI
	Han RN, Li XC, Zhao SB, et al. Construction and application of early rehabilitation scheme for Intensive Care Unit patients[J]. Chin J Nurs, 2020, 55(1):8-15. DOI

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