尿毒症患者应用CRRT时体外循环装置凝血的危险因素及预警模型.docx

尿毒症患者应用CRRT时体外循环装置凝血的危险因素及预警模型

[关键词]连续性肾脏替代治疗；尿毒症；凝血；危险因素；风险预警模型

[中图分类号]R692.5[文献标识码]A[DOI]10.3969/j.issn.1673-9701.2025.01.010

RiskfactorsandearlywarningmodelofcoagulationwithextracorporealcirculationdeviceinuremicpatientswithCRRT

SUNYuan，GUYunyu，HUANGYan

DepartmentofNephrology，theSecondAffiliatedHospitalofNanchangUniversity，Nanchang330006，Jiangxi，China

[Abstract]ObjectiveToinvestigatetheriskfactorsofcoagulationwithextracorporealcirculationdeviceinuremicpatientswithcontinuousrenalreplacementtherapy（CRRT），andestablishandverifytheriskwarningmodel.MethodsAtotalof210uremicpatientswhoreceivedCRRTtreatmentintheSecondAffiliatedHospitalofNanchangUniversityfromMarch2020toMarch2022wereretrospectivelyselectedastrainingset，anddividedintocoagulationgroupandnon-coagulationgroupaccordingtowhethercoagulationoccurredduringCRRTtreatment.Atthesametime，90uremicpatientswhounderwentCRRTtreatmentinourhospitalfromApril2022toApril2023wereselectedasvalidationsetaccordingtotheratioof7：3.UnivariateanalysisandmultivariateLogisticregressionwereusedtoanalyzethefactorsrelatedtocoagulationwithextracorporealcirculationdeviceinuremicpatientswithCRRT，andariskpredictionmodelwasconstructed.Thereceiveroperatingcharacteristic（ROC）curvewasusedtoverifythepredictionefficiencyofthemodel.ResultsIntrainingset，53patientshadcoagulationwithextracorporealcirculationdevice，theincidencewas25.24%.MultivariateLogisticregressionanalysisshowedthatage≥60yearsnbsp;old，agitation，decreasedbloodflow，elevatedplateletcount，andelevatedtransmembranepressurewereallriskfactorsforcoagulationinpatientswithuremiatreatedwithCRRT（Plt;0.05）.TheHosmer-Lemeshowtestresultsofthetrainingsetshowedthatthemodelhadagoodgoodnessoffitting，andareaunderthecurve（AUC）ofthemodelwas0.956（95%CI：0.926-0.985，Plt;0.05）whenCRRTwasappliedtouremicpatients，andthesensitivitywas86.40%，thespecificitywas83.80%.Thegoodnessoffittingofthevalidationsetwasgood.TheAUCofthepredictionmodelwas0.946（95%CI：0.915-0.977，Plt;0.05），thesensitivitywas82.60%，andthespecificitywas81.8