心力衰竭患者血液超滤治疗发生低血压的列线图风险模型构建

摘要/Abstract

摘要： 目的探究心力衰竭患者血液超滤治疗发生低血压的列线图风险模型构建。方法选取2023年1月至2024年12月于本院实施血液超滤的心力衰竭患者80例。根据患者治疗后有无低血压分为低血压组（n=26）和非低血压组（n=54）。记录两组患者的一般资料,通过Logistic回归分析确定心力衰竭患者血液超滤治疗发生低血压的影响因素,建立风险预测模型的列线图,并绘制受试者工作特征（ROC）曲线对预测模型进行评估。结果低血压组收缩压低于非低血压组[（150.33±12.42 vs 118.65±14.28）mmHg],差异具有统计学意义（P<0.05）;低血压组血磷[（2.53±0.67 vs 1.72±0.56）mmol/L]、血浆白蛋白[（36.72±4.97 vs 40.78±5.62）g/L]、CRP[（8.86±0.97 vs 3.85±0.58）mg/L]、超滤速率[（280.05±45.36 vs 220.53±40.64）mL/h]均高于非低血压组,差异具有统计学意义（P<0.05）。结果显示,血磷、血浆白蛋白、超滤速率是心力衰竭患者血液超滤治疗发生低血压的危险因素[比值比（odds ratio,OR）=1.863、2.258、2.752,P<0.05]。根据影响因素构建出列线图模型,曲线下面积为0.948（95%CI：0.874-0.985）,灵敏度为88.89%,特异性为88.46%。结论本研究构建的列线图模型能有效预测心力衰竭患者血液超滤治疗中的低血压风险,关键因素包括超滤速率、血浆白蛋白及血磷水平。

关键词: 心力衰竭, 血液超滤, 低血压, 风险, 模型构建

Abstract: Objective To construct a nomogram risk model for hypotension in patients with heart failure undergoing blood ultrafiltration. Methods A total of 80 patients with heart failure who underwent blood ultrafiltration in our hospital from January 2023 to December 2024 were enrolled, and according to the presence or absence of hypotension after treatment, the patients were divided into hypotension group with 26 patients and non-hypotension group with 54 patients. General information was recorded for both groups, and the logistic regression analysis was used to investigate the influencing factors for hypotension in patients with heart failure undergoing blood ultrafiltration. A nomogram was constructed for the risk prediction model, and the receiver operating characteristic (ROC) curve was plotted to assess the predictive model. Results Compared with the non-hypotension group, the hypotension group had a significantly lower systolic blood pressure (118.65±14.28 mmHg vs 150.33±12.42 mmHg, P<0.05) and significantly higher blood phosphorus (2.53±0.67 mmol/L vs 1.72±0.56 mmol/L, P<0.05), plasma albumin (40.78±5.62 g/L vs 36.72±4.97 g/L, P<0.05), CRP (8.86±0.97 mg/L vs 3.85±0.58 mg/L, P<0.05), and ultrafiltration rate (280.05±45.36 mL/h vs 220.53±40.64 mL/h, P<0.05). The results showed that blood phosphorus, plasma albumin, and ultrafiltration rate were risk factors for hypotension in patients with heart failure undergoing blood ultrafiltration (odds ratio=1.863, 2.258, and 2.752, P<0.05). A nomogram model was constructed based on the influencing factors, with an area under the ROC curve of 0.948 (95% confidence interval: 0.874-0.985), a sensitivity of 88.89%, and a specificity of 88.46%. Conclusion The nomogram model constructed in this study can effectively predict the risk of hypotension in patients with heart failure during blood ultrafiltration, and the key factors include ultrafiltration rate, plasma albumin, and blood phosphorus.

Key words: Heart failure, Blood ultrafiltration, Hypotension, Risk, Model construction

高伟, 王艺鹏, 郝青青. 心力衰竭患者血液超滤治疗发生低血压的列线图风险模型构建[J]. 心血管病防治知识, 2026, 16(12): 18-22.

GAO Wei, WANG Yipeng, HAO Qingqing. Construction of a nomogram risk model for hypotension in heart failure patients undergoing blood ultrafiltration[J]. Prevention and Treatment of Cardiovascular Disease, 2026, 16(12): 18-22.

参考文献

[1] 庞大艳,陈学高. 婴幼儿呼吸道合胞病毒毛细支气管炎病情程度的影响因素分析[J]. 中国国境卫生检疫杂志,2024,47(6):604-608.
[2] Pinter J, Smyth B, Stuard S,et al.Effect of Dialysate and Plasma Sodium on Mortality in a Global Historical Hemodialysis Cohort[J]. J Am Soc Nephrol,2024,35(2):167-176.
[3] 彭舒瑶,蔡娟,李潘华. 对毛细支气管炎患儿实施规范化护理干预的效果研究[J]. 中国标准化,2024(2):252-255.
[4] Lefranc Torres A, Correa S, Mc Causland FR.Association of Calcium Channel Blocker Use With Intradialytic Hypotension in Maintenance Hemodialysis[J]. Kidney Int Rep, 2024,9(6):1758-1764.
[5] 叶桥华,李小玉,江凤琼,等. 婴儿毛细支气管炎辅助排痰优化方案的比较研究[J]. 护理研究,2023,37(24):4539-4541.
[6] 郎艳美,李攀,李丹丹,等. 婴幼儿毛细支气管炎后反复喘息的危险因素分析[J]. 河北医药,2023,45(21):3245-3250.
[7] 黄震华. 心室收缩不同步的心功能Ⅰ-Ⅱ级患者应用心脏再同步化治疗[J].中国新药与临床杂志,2013,32(5):358-361.
[8] Iwashima Y, Fukushima H, Horio T,et al.Blood pressure, arterial waveform, and arterial stiffness during hemodialysis and their clinical implications in intradialytic hypotension[J]. Hypertens Res, 2023,46(3):697-707.
[9] 秦明明,张洪旭,章超群,等. 平均红细胞体积、红细胞分布宽度与血液透析患者透析中低血压的相关性分析[J]. 临床肾脏病杂志,2022,22(7):553-559.
[10] 李昂,杨俊伟. 血液超滤在急性失代偿性心力衰竭中的应用进展[J]. 中国心血管病研究,2024,22(2):97-101.
[11] 谭鹏进,李馨,王丽宁,等. 急性心力衰竭患者接受超滤治疗对肾功能的影响[J]. 中国循证心血管医学杂志,2022,14(7):844-847.
[12] Wang Z, Li H, Sun L,et al.Efficacy and safety of ultrafiltration combined with haemodialysis in patients with uraemia who cannot tolerate dialysis because of hypotension[J]. Acta Cardiol, 2024,79(5):599-604.
[13] 李敬,郝盼盼. 急性心力衰竭患者出入院心率变化与预后相关性[J]. 山东大学学报(医学版),2025,63(4):75-82.
[14] 鲍霞,徐佳美,黄春香,等. 艾考糊精透析液在腹膜透析患者心力衰竭中的应用效果观察[J]. 中国中西医结合肾病杂志,2025,26(3):234-236.
[15] 贾红丹,毕希乐,赵云凤,等. 血压动态监测沙库巴曲缬沙坦治疗慢性心力衰竭低血压及低血压发生的高危因素研究[J]. 临床和实验医学杂志,2023,22(12):1251-1254.