Abstract:

Objective　To analyze the risk factors for peritoneal dialysis (PD) catheter blockage after operation for complex congenital heart disease and construct a prediction model, so as to provide reference for smooth implementation of PD after operation for complex congenital heart disease. Methods　A prospective study was conducted, and 120 children who underwent PD after operation for complex congenital heart disease in Fuwai Central China Cardiovascular Hospital from December 2022 to February 2024 were selected as the research subjects. Among them, there were 82 boys and 38 girls, aged 6 months-3 years. There were 52 cases of tetralogy of Fallot, 37 cases of transposition of the great arteries, 28 cases of ventricular septal defects, and 3 other cases. All the children received PD treatment. The incidence of PD catheter blockage was analyzed, and the children were divided into a catheter blockage group (81 cases) and a non-catheter blockage group (39 cases) according to the presence/absence of catheter blockage. Univariate and multivariate logistic regression analysis were performed to identify the risk factors for PD catheter blockage after operation for complex congenital heart disease. A prediction model was constructed, and the predictive value of the prediction model was evaluated by the receiver operating characteristic curve (ROC). χ² test and t test were used for statistical analysis. Results　In this study, 81 children experienced catheter blockage after the first PD, with an incidence rate of 67.50% (81/120). The proportions of children under 1 year old, children undergoing catheterization at the right rectus abdominis, children with catheter displacement, children with twisted catheter, children without preventive medication during PD, and children with greater omentum wrapping in the catheter blockage group were higher than those in the non-catheter blockage group [85.19% (69/81) vs. 58.97% (23/39), 72.84% (59/81) vs. 25.64% (10/39), 32.10% (26/81) vs. 12.82% (5/39), 35.80% (29/81) vs. 15.38% (6/39), 69.14%(56/81) vs. 23.08%(9/39), 40.74% (33/81) vs. 20.51% (8/39)], with statistically significant differences (all P<0.05). Logistic regression analysis showed that catheter displacement (odds ratio =1.670, 95% confidence interval 1.079-2.586), twisted catheter (odds ratio =1.642, 95% confidence interval 1.219-2.212), and greater omentum wrapping (odds ratio =1.592, 95% confidence interval 1.208-2.099) were the risk factors for PD catheter blockage after operation for complex congenital heart disease, and preventive medication during PD was a protective factor (odds ratio =0.676, 95% confidence interval 0.536-0.852). According to the logistic regression analysis results, a prediction model was constructed. ROC analysis results showed that the sensitivity, specificity, area under the curve (AUC), and Youden index of the model were 84.62%, 79.69%, 0.865, and 0.643. Compared with the actual value, the accordance rate of the model was 95.00% [(78+36)/120]. Conclusions　There are multiple risk factors for PD catheter blockage after operation for complex congenital heart disease, including catheter displacement, twisted catheter, greater omentum wrapping, and preventive medication during PD. The prediction model constructed based on these factors helps to early identify the risk of catheter blockage, which is expected to provide reference for smooth implementation of PD after operation for complex congenital heart disease.

Key words:

Peritoneal dialysis, Complex congenital heart disease, Catheter blockage, Risk factors, Prediction model, Children

摘要：

目的　分析复杂性先天性心脏病术后腹膜透析导管堵塞的危险因素，构建预测模型，为复杂性先天性心脏病术后腹膜透析的顺利开展提供参考。方法　本研究为回顾性分析。选取2022年12月至2024年2月阜外华中心血管病医院120例复杂性先天性心脏病术后患儿为研究对象，其中男82例，女38例，年龄6个月～3岁，法乐四联征52例、大动脉转位37例、室间隔缺损28例、其他3例。所有患儿均接受腹膜透析治疗，统计首次腹膜透析后导管堵塞情况，并依据有无导管堵塞分为堵塞组（81例）及未堵塞组（39例）。单因素和多因素logistic回归分析影响腹膜透析导管堵塞的危险因素，构建预测模型。采用受试者操作特征曲线（ROC）评价预测模型的预测价值。采用χ²检验、t检验进行统计分析。结果　120例复杂性先天性心脏病术后患儿首次腹膜透析后，出现导管阻塞81例，发生率为67.50%。堵塞组年龄<1岁、置管切口位置为右侧腹直肌、导管移位、导管扭曲、腹膜透析期间无预防用药、大网膜包裹占比均高于未堵塞组［85.19%（69/81）比58.97%（23/39）、72.84%（59/81）比25.64%（10/39）、32.10%（26/81）比12.82%（5/39）、35.80%（29/81）比15.38%（6/39）、69.14%（56/81）比23.08%（9/39）、40.74%（33/81）比20.51%（8/39）］，差异均有统计学意义（均P<0.05）。logistic回归分析结果显示，导管移位（比值比=1.670，95%置信区间 1.079～2.586）、导管扭曲（比值比=1.642，95%置信区间 1.219～2.212）、大网膜包裹（比值比=1.592，95%置信区间 1.208～2.099）均是腹膜透析导管堵塞的危险因素，腹膜透析期间预防用药为保护因素（比值比=0.676，95%置信区间 0.536～0.852）。依据logistic回归分析结果构建预测模型，ROC结果示模型灵敏度为84.62%，特异度为79.69%，曲线下面积为0.865，约登指数为0.643。该模型预测复杂性先天性心脏病术后患儿腹膜透析导管堵塞的预测值与实际值符合率为95.00%［（78+36）/120］。结论　导管移位、导管扭曲、大网膜包裹均是复杂性先天性心脏病术后患儿腹膜透析导管堵塞的危险因素，腹膜透析期间预防用药为其保护因素。依据影响因素构建的预测模型，可早期识别导管堵塞发生风险，有望为复杂性先天性心脏病术后患儿腹膜透析的顺利开展提供参考。

关键词:

腹膜透析, 复杂性先天性心脏病, 导管堵塞, 危险因素, 预测模型, 儿童