摘要
目的探讨慢性心力衰竭患者并发Ⅱ型心肾综合征的危险因素,并建立风险预警模型。方法选取2015年1月至2021年8月某医院收治的472例慢性心力衰竭患者作为研究对象,根据患者是否发生Ⅱ型心肾综合征分为Ⅱ型心肾综合征组和非Ⅱ型心肾综合征组。收集两组患者临床资料进行单因素和多因素回归分析,得出独立预测因素,基于此构建列线图风险模型,并对该模型进行预测效能的评价。结果共计120例慢性心力衰竭患者发生Ⅱ型心肾综合征,发生率为25.42%。患者年龄≥71岁(OR=8.295,95%CI:4.376,15.725)、合并糖尿病(OR=2.386,95%CI:1.328,4.287)、合并高血压(OR=2.391,95%CI:1.341,4.262)、心功能分级Ⅳ级(OR=3.574,95%CI:1.955,6.532)、肾小球滤过率≤67.69 mL/(min·1.73 m^(2))(OR=8.663,95%CI:4.739,15.835)及C反应蛋白≥14.08 mg/L(OR=7.092,95%CI:3.955,12.716)、是慢性心力衰竭患者并发Ⅱ型心肾综合征的独立危险因素(P<0.05)。基于以上影响因素建立列线图风险模型,模型验证结果显示,初始模型一致性指数为0.905,与1000次Bootstrap内部验证的一致性指数0.918较为接近,校正曲线显示该列线图模型具有良好的区分度及一致性。结论慢性心力衰竭患者具有较高的Ⅱ型心肾综合征发生率。患者年龄、合并糖尿病和高血压、心功能分级、肾小球滤过率、C反应蛋白与Ⅱ型心肾综合征发生具有密切关系,基于此建立的列线图模型有助于临床护理人员在早期识别Ⅱ型心肾综合征高危患者。
Objective To investigate the risk factors of chronic heart failure(CHF)combined with cardiorenal syndrome type Ⅱ(CRS-Ⅱ)and establish a risk warning model.Methods A total of 472 CHF patients who were admitted to a hospital from January 2015 to August 2021 were selected as the research objects.The patients were divided into CRS-Ⅱ group and non-CRS-Ⅱ group according to whether the patients had CRS-Ⅱ.Collect two groups of clinical data for single-factor and multi-factor regression analysis to obtain independent predictive factors,build a nomogram risk model based on this,and evaluate the predictive efficacy of the model.Results A total of 120 CHF patients developed CRS-Ⅱ,with an incidence rate of 25.42%.Patients age≥71 years old(OR=8.295,95%CI:4.376,15.725),combined with diabetes(OR=2.386,95%CI:1.328,4.287),combined with hypertension(OR=2.391,95%CI:1.341,4.262),cardiac function classification grade IV(OR=3.574,95%CI:1.955,6.532),eGFR≤67.69 mL/(min·1.73 m^(2))(OR=8.663,95%CI:4.739,15.835)and CRP≥14.08 mg/L(OR=7.092,95%CI:3.955,12.716)were independent risk factors for CHF patients with CRS-Ⅱ(P<0.05).A nomogram risk model was established based on the above influencing factors.The model verification results showed that the initial model consistency index was 0.905,which was close to the consistency index of 0.918 verified within Bootstrap for 1000 times.The correction curve showed that the line graph model had good differentiation and consistency.Conclusion There is a high incidence of CRS-Ⅱ in patients with CHF.Patients'age,diabetes,hypertension,cardiac function classification,eGFR and CRP are closely related to the occurrence of CRS-Ⅱ.The established nomogram model is helpful for clinical nurses to identify CRS-Ⅱ high-risk patients in the early stage.
作者
宋雪
林芳
王育林
杨静
廉小磊
叶静
蔡宇霄
SONG Xue;LIN Fang;WANG Yulin;YANG Jing;LIAN Xiaolei;YE Jing;CAI Yuxiao(Department of Geriatrics,Cardiac Electrophysiology Center,Mianyang Hospital,School of Medicine,University of Electronic Science and Technology,Mianyang 621000,China)
出处
《护理管理杂志》
CSCD
2023年第4期239-243,共5页
Journal of Nursing Administration
基金
四川省卫生健康科研课题立项项目(20PJ264)
关键词
慢性心力衰竭
心肾综合征
风险因素
预警模型
列线图
chronic heart failure
cardiorenal syndrome
risk factor
early warning model
nomogram
作者简介
宋雪,本科,主管护师,护士长;通信作者:林芳,E-mail:672242586@qq.com
