预测血液透析患者发生低血压的风险列线图模型的建立及护理对策

Establishment of nomogram model for predicting the risk of hypotension in hemodialysis patients and nursing countermeasures

目的分析血液透析患者发生低血压(IDH)的危险因素,并建立风险列线图模型以制定合理化护理对策。方法回顾性分析2018年1月-2019年12月200例血液透析患者的临床资料,采用单因素和多因素Logistic回归分析发生IDH的独立危险因素,并建立相关风险预测列线图模型,以制定合理化预防护理对策。结果本研究多因素分析结果显示,高龄、糖尿病肾衰竭、高甲状旁腺素、自主神经功能病变、营养不良是血液透析患者发生IDH的独立危险因素(P<0.05)。基于以上5项独立危险因素构建风险列线图模型,并验证模型精确度和区分度,实际值基本与预测值大小一致,C-index指数为0.817(95%CI:0.798-0.845),表明该风险列线图模型精准度和区分度较好。结论高龄、糖尿病肾衰竭、高甲状旁腺素、自主神经功能病变、营养不良是血液透析患者发生IDH的独立危险因素,本研究建立的风险列线图模型精准度和区分度较好。

Objective To analyze the risk factors of hypotension in hemodialysis patients and establish a risk nomogram model to formulate reasonable nursing countermeasures.Methods The clinical data of hemodialysis patients from January 2018 to December 2019 were retrospectively analyzed.The independent risk factors of hypotension were analyzed by univariate and multivariate logistic regression,and the related risk prediction nomogram model was established to formulate reasonable preventive nursing countermeasures.Results Elderly,diabetic renal failure,high parathyroid hormone(PTH),autonomic neuropathy and malnutrition were independent risk factors of hypotension in hemodialysis patients(P<0.05).Based on the above five independent risk factors,the risk nomogram model was constructed,and the accuracy and differentiation of the model were verified.The actual value was basically consistent with the predicted value.The c-index index was 0.817(95%CI:0.798-0.845),indicating that the accuracy and differentiation of the risk nomogram model were better.Conclusion Elderly,diabetic renal failure,high parathyroid hormone(PTH),autonomic neuropathy and malnutrition are independent risk factors of hypotension in hemodialysis patients.The accuracy and discrimination of risk nomogram model established in this study is good,and it has high clinical application value.