【作者】 刘莉莉；

【导师】 张晓良；

【作者基本信息】 东南大学 ， 临床医学， 2021， 硕士

【摘要】 目的:探讨应用带隧道带涤纶套导管(Tunnel-cuffed Catheter,TCC)血液透析患者并发导管相关性血流感染的危险因素,并建立血液透析患者并发导管相关性血流感染的列线图预测模型。方法:回顾性分析2013年6月-2019年12月东南大学附属中大医院肾内科行TCC置管进行维持性血液透析的285例终末期肾脏病患者,将所有患者按7:3随机分为训练组和验证组,分析相关临床资料。使用logistic回归单因素、多因素分析筛选应用TCC进行血液透析患者并发导管相关性血流感染的危险因素。并根据多因素分析得出的危险因素建立导管相关性血流感染预测模型,并对预测模型进行验证。结果:根据纳排标准共纳入285例(男125例,女160例)患者。训练组198人,42人出现导管相关性血流感染,感染率21.2%;验证组87人,感染20人,感染率23%。对训练组患者临床资料进行logistic回归分析,单因素分析结果显示吸烟史、贫血、糖尿病、NLR及导管留置时间≥1年为并发导管相关性血流感染的潜在危险因素(P<0.05)。多因素分析结果显示吸烟史、贫血、糖尿病及导管留置时间≥1年为应用TCC血液透析患者并发导管相关性血流感染的潜在独立危险因素(P<0.05)。为筛选TCC血液透析患者并发导管相关性血流感染的高危人群,纳入吸烟史、贫血、糖尿病三个危险因素建立维持性血液透析患者并发导管相关性血流感染的列线图预测模型,预测模型在训练组和验证组中的C指数分别为0.761和0.714。同时,校正曲线显示,预测模型具有良好的校准能力;DCA决策曲线表明模型具有较好的临床应用价值。结论:吸烟史、贫血、糖尿病、导管留置时间≥1年均为导管相关性血流感染发生的潜在独立危险因素,由此建立的预测模型能够有效筛选应用TCC血液透析患者并发导管相关性血流感染的高危人群,尽早予以干预,更严密的进行监测,从而降低高危人群导管相关性血流感染的发生率。更多还原

【Abstract】 Objectives: To explore the risk factors of tunnel-cuffed catheter related bloodstream infection in patients with tunnel-cuffed catheterization hemodialysis,and to establish a predictive model for catheter-related bloodstream infection.Methods: 285 patients with end-stage renal disease who underwent tunnel-cuffed catheterization in the Department of Nephrology,Zhongda Hospital Affiliated to Southeast University from June 2013 to December 2019 were included.All patients were randomly divided into training cohort and validation cohort at a ratio of 7:3.The clinical and general data were analyzed retrospectively.Logistic regression analysis was used to select the independent risk factors of catheter-related bloodstream infection in patients with tunnel-cuffed catheter hemodialysis.A predictive model for catheter-related bloodstream infection in tunnel-cuffed catheterization hemodialysis patients was developed based on the result of multivariate analyses.And the predictive ability and accuracy of the model were verified.Results: A total of 285 patients were enrolled,the training cohort consisted of 198 patients,the remaining 87 patients was allocated as the validation cohort.In the training cohort,42 people had catheter-related bloodstream infections,with an infection rate of 21.2%.In the validation cohort,20 people were infected,with an infection rate of 23%.The results of logistic univariate analysis showed that smoking history,anemia,diabetes,NLR and catheter indwelling time ≥1 year were potential risk factors for catheter-related bloodstream infection(P<0.05).The results of multivariate analysis showed that smoking history,anemia,diabetes,and catheter indwelling time ≥1 year were potential independent risk factors for catheter-related bloodstream infection in patients with tunnel-cuffed catheter hemodialysis(P<0.05).In order to select the high-risk groups of tunnel-cuffed catheter hemodialysis patients with catheter-related bloodstream infection,the three risk factors of smoking history,anemia,and diabetes were included to establish a predictive model to predict the catheter-related bloodstream infection of maintenance hemodialysis patients.The C-index of the nomogram was 0.761 and 0.714 in the training cohort and validation cohort,respectively.At the same time,the calibration curve shows that the prediction model has good calibration capabilities.The DCA decision curve shows that the predictive model has good clinical application value.Conclusion: Smoking history,anemia,diabetes,and catheter indwelling time ≥1 year are potential independent risk factors for catheter-related bloodstream infections.The predictive model based on these factors can effectively select the high-risk group of tunnel-cuffed catheter-related hemodialysis patients with catheter-related bloodstream infection.So that we can intervene as soon as possible and conduct more rigorous monitoring to reduce the incidence of catheter-related bloodstream infections in high-risk populations.更多还原