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

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。

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