目的 探讨新生儿经外周静脉留置中心静脉导管（peripherally inserted central catheter,PICC）相关并发症的高危因素。方法 回顾性分析2023年1月—2024年12月我院新生儿外科实施PICC置管550例新生儿的临床资料,根据新生儿住院期间是否发生PICC相关并发症将其分为发生并发症组（120例）和未发生并发症组（430例）。采用单因素和多因素Logistic回归分析法分析PICC相关并发症的高危因素,建立回归方程,并采用受试者工作特征（receiver operating characteristic,ROC）曲线分析回归方程对新生儿外科PICC相关并发症的预测价值。结果 本研究的120例发生PICC相关并发症新生儿中,导管尖端异位32例,静脉炎40例,相关血栓20例,导管堵塞28例。较未发生并发症组,发生并发症组出生体重更低,胎龄<36周、经头静脉置管、导管尖端未到达预期位置、PICC输注血管活性药每日冲管次数≤2次、羊水污染、脐带异常、其他侵入性操作、禁食时间>10 d、PICC留置时间>28 d的新生儿占比更高。多因素Logistic回归分析结果显示,出生体重低、胎龄<36周、导管尖端未到达预期位置、PICC留置时间>28 d、禁食时间>10 d是新生儿外科PICC相关并发症的高危因素。建立新生儿外科PICC相关并发症预测回归方程：logit（P）=-6.845+出生体重×0.435+胎龄×0.874+导管尖端是否到达预期位置×0.643+PICC留置时间×0.231+禁食时间×1.354。对该回归方程进行评价,回归方程建立具有统计学意义;回归方程的系数差异亦有统计学意义。采用Hosmer-Lemeshow拟合优度检验显示拟合效果较好。按照logit（P）绘制预测新生儿外科PICC相关并发症的ROC曲线,显示该回归方程预测新生儿外科PICC相关并发症价值较高。结论 出生体重低、胎龄<36周、导管尖端未到达预期位置、PICC留置时间>28 d、禁食时间>10 d是新生儿外科PICC相关并发症的高危因素,构建的回归方程有效,具有较高预测价值,临床可据此尽早筛选高危新生儿并采取针对性干预措施以降低外科PICC相关并发症发生率。

Objective To explore the high risk factors of complications related to peripherally inserted central catheter (PICC) in neonatal surgery. Methods The clinical data of 550 newborns who underwent PICC catheterization in neonatal surgery in our hospital from January 2023 to December 2024 were retrospectively analyzed. According to whether PICC-related complications occurred during hospitalization, the newborns were divided into complication group (120 cases) and non-complication group (430 cases). The high risk factors of PICC-related complications in neonatal surgery were analyzed by univariate and multivariate Logistic regression analysis, and the regression equation was established. The predictive value of the regression equation for PICC-related complications in neonatal surgery was analyzed by receiver working characteristics (ROC) curve. Results Among the 120 newborns with PICC-related complications, there were 32 cases of ectopic catheter tip, 40 cases of phlebitis, 20 cases of related thrombosis and 28 cases of catheter blockage. Compared with the group without complications, the birth weight in the group with complications was lower, and the proportion of newborns with gestational age<36 weeks, catheter tip not reaching the expected position, flushing frequency of PICC for vasoactive drug infusion ≤2 times a day, amniotic fluid pollution, umbilical cord abnormality, other invasive operations, fasting time>10 d and PICC indwelling time>28 d was higher. Multivariate Logistic regression analysis showed that low birth weight, gestational age<36 weeks, catheter tip not reaching the expected position, PICC indwelling time>28 d and fasting time>10 d are the high risk factors of PICC-related complications in neonatal surgery. The regression equation was established as follows: logit (P) =-6.845+ birth weight ×0.435+ gestational age ×0.874+ whether the catheter tip reaches the expected position ×0.643+PICC indwelling time ×0.231+ fasting time ×1.354. The Logistic regression equation for the diagnosis of PICC-related complications in neonatal surgery was evaluated. The establishment of the regression equation was statistically significant, the coefficient difference of the regression equation was statistically significant. Hosmer-Lemeshow goodness of fit test shows that the fitting effect was good, The ROC curve for predicting PICC-related complications in neonatal surgery was plotted based on the diagnostic probability logit (P), demonstrating a high predictive value of the regression equation. Conclusion Low birth weight, gestational age<36 weeks, catheter tip not reaching the expected position, PICC indwelling time>28 d and fasting time>10 d were the high-risk factors of PICC-related complications in neonatal surgery. The regression equation was effective and had high predictive value, so we could screen high-risk newborns as soon as possible and take targeted interventions to reduce the incidence of PICC-related complications in surgery.