ICU老年危重症患者留置中长导管期间静脉血栓形成的危险因素及预防策略分析

Analysis of risk factors and preventive strategies for venous thrombosis in elderly critically ill patients during medium-long catheter indwelling in ICU

中文关键词: 老年, 静脉血栓, 中等长度导管, 危险因素, 重症疾病, 感染

英文关键词: elderly  venous thrombosis  medium-long catheter  risk factor  critically illness  infection

中文摘要:

      目的 探讨重症加强护理病房(ICU)老年危重症患者留置中长导管期间静脉血栓(VTE)形成情况、危险因素及其预防策略.方法 选取2020年1月-2023年4月在青岛市胶州中心医院重症医学科收治的278例留置中长导管老年危重症患者,按有无发生VTE分为发生组(n=60)和未发生组(n=218).对2组患者一般资料进行比较,分析老年危重症患者VTE形成危险因素,采用受试者工作特征(ROC)分析回归模型对老年危重症患者VTE形成的预测价值.结果 发生组的年龄、急性生理和慢性健康评估Ⅱ(APACHE Ⅱ)评分较未发生组高,Glasgow昏迷量表(GCS)评分较未发生组低,且导管感染情况更多,差异均有统计学意义(P＜0.05).Logistic回归结果显示,患者年龄＞80岁、APACHEⅡ评分≥20分、纤维蛋白原(Fib)水平升高均为影响ICU留置中长导管老年危重症患者VTE发生的独立危险因素(P＜0.05).构建ICU留置中长导管老年危重症患者VTE发生回归方程,Logit(P)=-6.281+2.560 ×年龄+10.231 × APACHE Ⅱ评分+5.402 ×Fib 水平.采用 Hosmer-Lemeshow 检验,Hosmer-Lemeshow x2=6.324,P=0.511,说明该模型拟合优度较好.该风险评估模型对推导组数据进行预测,得到ROC曲线下面积(AUC)=0.719(95％CI:0.615～0.809).结论 患者年龄＞80岁、APACHE Ⅱ评分≥20分、Fib水平升高均可能是重症疾病患者发生VTE的独立危险因素,将上述危险因素进行权重分配,整合并为评估模型对患者术后迟发性出血具有中等预测效能,临床医师在治疗时应重视上述因素,并对疾病进展进行积极控制,以减少发生VTE的风险.

英文摘要:

      Objective To explore the risk factors and preventive strategies for venous thrombosis(VTE)in elderly crit-ically ill patients during medium-long catheter indwelling in intensive care unit(ICU).Methods 278 elderly critically ill pa-tients who underwent medium-long catheter indwelling in Department of Critical Care Medicine,Jiaozhou Central Hospital from January 2020 to April 2023 were selected.According to presence or absence of VTE,they were divided into occurrence group(n=60)and non-occurrence group(n=218).The general data of the two groups were compared.The risk factors for VTE in elderly critically ill patients were analyzed.Receiver operating characteristic(ROC)was used to analyze the predictive value of a regression model for VTE in elderly critically ill patients.Results The age and score of Acute Physiological and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)in the occurrence group were higher than those in the non-occurrence group,the score of Glasgow Coma Scale(GCS)was lower than that in the non-occurrence group,and the incidence of catheter infection was high-er than that in the non-occurrence group(P＜0.05).Logistic regression results showed that patient'age＞80 years,APACHEⅡ score≥20 points,and elevated fibrinogen(Fib)level were independent risk factors for VTE in critically ill elderly patients undergoing medium-long catheter indwelling in ICU(P＜0.05).A regression equation was established for the occurrence of VTE in elderly critically ill patients undergoing medium-long catheter indwelling in ICU:Logit(P)=-6.281+2.560 xage+10.231 xAPACHE Ⅱ score+5.402 x Fib level.The results of Hosmer-Lemeshow test showed that x2=6.324,P=0.511,in-dicating that the model had a good goodness of fit.This risk assessment model was used to predict the data of the deduction group,and the area under ROC curve(AUC)was 0.719(95％CI:0.615-0.809).Conclusion Patients'age＞80 years,APACHE Ⅱ score ≥20 points and elevated Fib may be independent risk factors for VTE in critically ill patients.The assess-ment model based on these risk factors has moderate predictive efficiency for postoperative delayed hemorrhage in critically ill patients.Clinicians should pay attention to the above factors during treatment and actively control disease progression to reduce the risk of VTE.