连续性肾脏替代治疗患者体外循环凝血风险预测模型的范围综述

doi:10.3761/j.issn.2096-7446.2025.11.017

摘要/Abstract

摘要：

目的对连续性肾脏替代治疗患者体外循环凝血风险预测模型的相关研究进行范围综述。方法计算机检索中英文数据库，收集自建库至2024年11月8日公开发表的关于连续性肾脏替代治疗患者体外循环凝血风险预测模型的相关文献，并进行描述性统计分析。结果共纳入8篇文献，多为单中心研究，建模样本量为79~1 752例，结局事件数为51~558个。模型构建方法包括Cox比例风险模型、Logistic回归模型和机器学习，受试者操作特征曲线下面积为0.732~0.898。出现频次最高的预测因子为抗凝方式、血流速度、活化部分凝血活酶时间和血小板计数。结论连续性肾脏替代治疗体外循环凝血风险预测模型对提前识别高风险患者、指导临床决策、降低凝血发生率及改善患者预后具有重要意义。目前模型的预测效能良好，但模型评价和验证不足，整体偏倚风险较高。未来研究需对现有模型进行优化，开发更为稳定且临床适用性高的预测模型。

关键词: 连续性肾脏替代治疗, 体外循环, 血液凝固, 模型, 统计学, 范围综述

Abstract:

Objective To review the related studies on the risk prediction model of extracorporeal circulation coagulation in patients with continuous renal replacement therapy. Methods The searches of Chinese and English databases were conducted to collect relevant literature on predictive models of coagulation risk in extracorporeal circulation in patients undergoing continuous renal replacement therapy that were publicly available from the time of database construction to November 8，2024，and the descriptive statistical analysis was conducted. Results A total of 8 literatures，mostly single-center studies，were included，with a modeling sample size of 79 to 1，752 cases and the number of outcome events ranging from 51 to 558. The model construction methods included cox proportional hazard model，logistic regression model and machine learning，and the area under the receiver operating characteristic curve was 0.732~0.898. The predictors that appeared the most frequently were anticoagulation modality，blood flow rate，APTT and platelet count. Conclusion The risk prediction model of extracorporeal circulation coagulation in continuous renal replacement therapy is of great significance for identifying high-risk patients in advance，guiding clinical decision-making，reducing the incidence of coagulation and improving patient prognosis. The current models had good predictive efficiency，but the model evaluation and validation were insufficient，and the overall risk of bias was high. Future studies need to optimize existing models and develop more stable and clinically applicable predictive models.

Key words: Continuous Renal Replacement Therapy, Extracorporeal Circulation, Blood Coagulation, Models, Statistical, Scoping Review

路娇, 司霞, 张颖惠, 张丽玉, 王彩玲. 连续性肾脏替代治疗患者体外循环凝血风险预测模型的范围综述[J]. 中华急危重症护理杂志, 2025, 6(11): 1386-1393.

LU Jiao, SI Xia, ZHANG Yinghui, ZHANG Liyu, WANG Cailing. A scoping review of risk predictive models for extracorporeal circulation coagulation in patients undergoing continuous renal replacement therapy[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(11): 1386-1393.

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