目的：构建ICU体外循环术后患者压力性损伤列线图预测模型并探讨其预测价值,为选择适合ICU体外循环术后患者的压力性损伤预测工具提供理论依据。方法：选择2021年1月―2021年12月入住某三级甲等医院ICU的268名体外循环术后患者为研究对象,收集其一般资料、治疗措施、实验室检查结果。通过Logistic回归分析筛选危险因素并构建列线图模型。应用受试者工作特征曲线下面积（AUC）、一致性指数评价模型区分度;校准曲线及Hosmer-Lemeshow检验评价模型校准度。结果：108例患者在ICU内发生压力性损伤,发生率为40.29%;Logistic回归分析显示血管活性药物评分（OR=1.246）、体外循环时长（OR=1.015）、APACHEII评分（OR=1.142）、IL-6（OR=1.003）为ICU体外循环术后患者压力性损伤独立危险因素。列线图模型AUC为0.865,灵敏度和特异度分别为0.907和0.780,一致性指数为0.916;Hosmer-Lemeshow检验：χ2=6.363,P=0.607,校准曲线显示列线图模型预测概率与实际概率一致程度较高。结论：列线图模型对ICU体外循环术后患者压力性损伤具有良好预测效能,有助于识别压力性损伤高风险患者。
Abstract
Objective To develop and validate a nomogram model for predicting pressure injury in critically ill patients after cardiopulmonary bypass,which provides a theoretical basis for selecting a pressure injury prediction tool suitable for patients after ICU cardiopulmonary bypass. Methods A total of 268 patients after cardiopulmonary bypass admitted to ICU of a general hospital from January 2021 to December 2021 were eligible for the candidates of this study. General data,treatment parameters,laboratory results and other data were collected from the electric hospital information system. The logsitic regression analysis was performed to detect the risk factors and to develop a nomogram prediction model. The area under receiver operating characteristic curve,calibration curve and decision curve were used to evaluate the prediction ability of the model. Results 1）108 patients developed pressure injury in ICU,the incidence of ICU,acquired pressure injury was approximately 40.29%.2）In logistic regression analysis,vasopressor inotropic score（OR=1.246）,duration of cardiopulmonary bypass（OR=1.015）,APACHEII（OR=1.142）and IL-6（OR=1.003）were identified as risk factors of pressure injury.3）The area under the curve of the model was 0.865,and the sensitivity and specificity were 0.907 and 0.780,respectively. The concordance index of the model was 0.916. Hosmer,lemeshow test：χ2=6.363, P=0.607. The calibration curve showed that it had a good consistency between the observed and actual probability. Conclusion The nomogram model has good predictive efficacy for pressure injury in ICU patients after cardiopulmonary bypass,which is helpful to identify patients with high risk of pressure injury.
关键词
重症监护 /
体外循环 /
压力性损伤 /
列线图模型
Key words
critical care /
cardiopulmonary bypass /
pressure injury /
nomogram
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基金
新疆维吾尔自治区自然科学基金“IL-6 对压力性损伤的影响及其机制研究”（2021D01C455）
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