造血干细胞移植儿童深静脉导管非计划拔管风险预测模型研究

Study on Risk Prediction Model for Unplanned Extubation of Deep Venous Catheter in Children with Hematopoietic Stem Cell Transplantation

目的建立移植层流病房地中海贫血造血干细胞移植患儿中心静脉置管非计划拔管发生风险的预测模型,为控制其发生提供临床借鉴。方法选取2017年1月至2020年12月107例符合纳入标准的患儿分别纳入计划拔管组(n=85)和非计划拔管组(n=22)进行单因素和多因素分析,利用logistic回归构建其风险预测模型,绘制ROC曲线,并检验模型预测价值。结果多因素logistic分析提示持续发热、缝线无效固定、患儿换药不配合和陪护者文化程度为地中海贫血移植患儿深静脉非计划拔管独立危险因素。预测模型ROC曲线下面积为0.942(95%CI:0.898~0.986,p=0.0000)。结论模型能够有效预测地中海贫血移植患儿非计划拔管的发生,可为移植层流病房医护人员及时识别高风险患儿采取预防性护理干预提供借鉴。

Objective To establish a risk prediction model for unplanned extubation of central venous catheterization in children with hematopoietic stem cell transplantation for thalassemia in laminar flow ward,so as to provide clinical reference for control the risk.Methods A total of 107 eligible children were included from January 2017 to December 2020 and divided into the planned extubation group(n=85)and the unplanned extubation group(n=22),and univariate and multivariate data analysis were conducted.Logistic regression was used to construct the risk prediction model,draw the characteristic ROC curve,and the prediction value of the model was tested.Results The multivariate logistic regression analysis indicated that continuous fever,failed suture fixation,patients’noncompliance with dressing change,and the educational background were the independent risk factors of unplanned extubation of central venous catheterization in children with hematopoietic stem cell transplantation for thalassemia.The area under the ROC curve of the prediction model was 0.942(95%CI:0.898~0.986,p=0.000).Conclusion This model can effectively predict the occurrence of unplanned extubation in children with hematopoietic stem cell transplantation for thalassemia,and can provide reference for medical staff in laminar flow ward to identify high-risk children and take preventive nursing intervention.