关键词: 肝癌, 化疗, 完全植入式静脉输液港, 并发症, 拔管, 预测模型, 静脉治疗, 护理

Abstract:

Objective To analyze the status quo and influencing factors of extubation due to complications of totally implantable access port in patients with liver cancer undergoing chemotherapy，to establish a risk prediction model，and to conduct internal validation of the model. Methods This study was a prospective nested case-control study. The patients with liver cancer undergoing chemotherapy for maintenance of totally implantable access port in a tertiary hospital in Shaanxi from October 2021 to September 2023 were selected as the investigation subjects. Patients with extubation due to complications were selected as an extubation due to complications group，and patients with planned extubation were randomly selected as a planned extubation group according to the matching number of 1 ∶ 10. Univariate analysis and Logistic regression analysis were used to explore the influencing factors of extubation due to complications. A visual nomogram risk prediction model was established，and the model was internally verified by receiver operating characteristic（ROC） curve，calibration curve and Hosmer-Lemeshow fit test. Results The incidence of extubation due to complications of totally implantable access port in patients with liver cancer undergoing chemotherapy was 7.0%. Infection（36.7%） and thrombosis（30.0%） were the main causes of extubation due to complications. BMI，TNM staging，diabetes，the number of catheter lumens in the access port and the chemotherapy times were the main influencing factors of extubation due to complications（P<0.05）. The area under ROC curve of the prediction model was 0.871；the best cut-off value was 0.106；the sensitivity was 0.800；the specificity was 0.820. The average absolute error between the actual and predicted values of the calibration curve was 0.011，and the calibration curve was close to the ideal curve. The Hosmer-Lemeshow goodness of fit test was χ²=2.913（P=0.940）. Conclusion The incidence of extubation due to complications of totally implantable access port in patients with liver cancer undergoing chemotherapy is low，and infection and thrombosis are the main reasons. Patients with a BMI≥24，TNM stage Ⅲ or Ⅳ，diabetes，double catheter lumens in the access port，and chemotherapy times>5 were at higher risk of extubation due to complications. The risk prediction model developed in this study demonstrates good predictive accuracy，and it can serve as a valuable tool for healthcare professionals in early identification of patients at risk for extubation due to complications.

Key words: Liver Neoplasm, Chemotherapy, Totally Implantable Access Port, Complications, Extubation, Prediction Model, Intravenous Therapy, Nursing Care