介入封堵术后PDA患儿并发血小板减少的早期预测及护理对策研究-现代医学

介入封堵术后PDA患儿并发血小板减少的早期预测及护理对策研究

单位：南京医科大学附属儿童医院心血管内科, 江苏南京 210000

分类号：R743.72

出版年·卷·期（页码）：2025·53·第二期（316-322）

摘要：

目的：分析儿童动脉导管未闭(patent ductus arteriosus，PDA)经导管介入封堵术术后并发血小板减少的风险因素以构建风险预测模型，并探讨相关的护理对策。方法：回顾性分析2022年1月至2024年5月在南京医科大学附属儿童医院接受介入封堵手术的221例PDA患儿的临床资料。依据术后血常规结果，分为血小板减少组和无血小板减少组。采用单因素分析和Logistic多因素回归分析筛选导管未闭经导管介入封堵术后发生血小板减少的风险因素，根据结果构建预测模型。结果：本研究纳入221名PDA患儿，血小板减少的发生率为14.03%(31/221)。Logistic回归分析显示，PDA直径≥3 mm (OR=2.928，95%CI：1.124～9.954)、封堵器直径＞8 mm (OR=2.268，95%CI：1.087～8.376)、残余分流(OR=3.109，95%CI：1.132～12.855)、合并其他畸形(OR=1.599，95%CI：1.018～5.718)是PDA患儿经导管介入封堵术后并发血小板减少的风险因素。基于多因素Logistic回归分析构建术后发生血小板减少的列线图模型，ROC曲线下面积为0.796(95%CI：0.733～0.859)，灵敏度和特异度分别为0.79和0.74。结合列线图与临床实践经验定义低危、中危、高危患儿的分值区间，低危组、中危组、高危组患儿血小板减少发生率分别为0.75%、20.83%、51.28%，差异有统计学意义(P＜0.001)。结论： PDA直径≥3 mm、封堵器直径＞8 mm、残余分流、合并其他畸形是影响PDA儿童经导管介入封堵术术后发生血小板减少的危险因素。根据以上风险因素构建的风险预测模型对术后护理有较大参考价值，有利于优化护理策略。

Objective: To investigate the determinants of thrombocytopenia following transcatheter closure in children with patent ductus arteriosus(PDA), to develop a predictive risk model and explore relevant nursing strategies. Methods: An examination of the medical records for 221 children with patent ductus arteriosus who underwent transcatheter closure at Nanjing Children's Hospital Affiliated to Nanjing Medical University from January 2022 to May 2024 was carried out. Post-operative blood routine results categorized patients into those with and without thrombocytopenia. Single-factor analysis and Logistic regression were employed to identify risk factors associated with thrombocytopenia following transcatheter closure. Subsequently, a predictive model was developed based on these findings. Results: The study included 221 children with PDA, and the incidence of thrombocytopenia was 14.03%(31/221). Logistic regression analysis revealed that PDA diameters ≥ 3 mm(OR=2.928, 95%CI:1.124-9.954), duct occluder diameters>8 mm(OR=2.268, 95%CI:1.087-8.376), residual shunting(OR=3.109, 95%CI:1.132-12.855), and other concurrent malformation(OR=1.599, 1.018-5.718) were risk factors for thrombocytopenia in children with patent ductus arteriosus following transcatheter closure. A nomogram model for the prediction of postoperative thrombocytopenia was constructed from the findings of the multivariate Logistic regression analysis, yielding an area under the ROC curve of 0.796(95%CI:0.733-0.859), with sensitivities and specificities of 0.79 and 0.74, respectively. By integrating the nomogram with clinical practice, low, intermediate, and high-risk patient score ranges were established. The incidences of thrombocytopenia in the low, intermediate, and high-risk patient groups were 0.75%, 20.83%, and 51.28%, respectively, demonstrating a substantial discrepancy(P<0.001). Conclusion: The PDA diameter ≥ 3 mm, duct occluder diameter>8 mm, residual shunting, and concurrent other malformation are risk factors for thrombocytopenia following catheter-based transcatheter closure of PDA in children. A risk prediction model developed from these risk factors provides significant reference value for postoperative care and helps optimize nursing strategies.

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