ISSN 2097-6046（网络）
ISSN 2096-7446（印刷）
CN 10-1655/R
主管：中国科学技术协会
主办：中华护理学会
中华急危重症护理杂志

中华急危重症护理杂志 ›› 2026, Vol. 7 ›› Issue (11): 1285-1292.doi: 10.3761/j.issn.2096-7446.2026.11.001

• 论著 •    下一篇

脉压变异度变化轨迹对危重患者连续性肾脏替代治疗早期低血压的预测研究

薛梦蝶1(), 陆素英2, 赵盟生3, 徐静娟4,*(), 赵成林2, 杨靖2   

  1. 1 苏州大学附属第一医院血液内科 苏州市 215500
    2 常州市第一人民医院重症医学科 常州市 213000
    3 南京医科大学公共卫生学院生物统计学系 南京市 211166
    4 常州市第一人民医院医疗行风办 常州市 213000
  • 收稿日期:2025-12-12 出版日期:2026-11-10 发布日期:2026-11-06
  • 通讯作者: *徐静娟，E-mail：heleneshue@sina.com
  • 作者简介:薛梦蝶：女，硕士，护师，E-mail：kayleexmd@foxmail.com
    作者贡献声明

    薛梦蝶：研究设计、文献检索、数据整理、论文撰写；陆素英：操作指导、工作支持、数据收集；赵盟生：数据整理、统计分析；徐静娟：研究指导、工作支持、论文审阅与修改；赵成林、杨靖：数据收集

Predictive role of pulse pressure variation trajectories in early hypotension among critically ill patients undergoing continuous renal replacement therapy

XUE Mengdie1(), LU Suying2, ZHAO Mengsheng3, XU Jingjuan4,*(), ZHAO Chenglin2, YANG Jing2   

  1. 1 Department of Hematology， the First Affiliated Hospital of Soochow University， Suzhou 215500， China
    2 Intensive Care Unit， Changzhou First People’s Hospital， Changzhou 213000， China
    3 Department of Biostatistics， School of Public Health，Nanjing Medical University， Nanjing 211166， China
    4 Medical Ethics and Conduct Office， Changzhou First People’s Hospital， Changzhou 213000， China.
  • Received:2025-12-12 Online:2026-11-10 Published:2026-11-06
  • Contact: *XU Jingjuan，E-mail：heleneshue@sina.com

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摘要：

目的 探究脉压变异度（pulse pressure variation，PPV）变化轨迹在危重患者连续性肾脏替代治疗（continuous renal replacement therapy，CRRT）早期透析相关性低血压（intra-dialytic hypotension，IDH）中的预测作用，并构建动态风险预测模型，为护理人员早期识别与干预提供依据。 方法 前瞻性收集2024年1月—2025年1月常州市某三级甲等医院重症医学科264例CRRT患者治疗相关资料，按7 ∶ 3分为训练集和验证集。采用最小绝对收缩和选择算子回归筛选IDH影响因素，使用联合潜在类别模型（joint latent class model，JLCM）识别PPV随时间变化的轨迹趋势，并构建动态预测模型，采用C指数、敏感度、特异度和时间依赖受试者操作特征曲线下面积（area under the curve，AUC）评估模型性能。 结果 IDH发生率为39.6%。使用胶体溶液、较高的基线平均动脉压和血小板计数是IDH的保护因素，较高的体重指数为危险因素。JLCM识别出3种PPV轨迹类别，分别为高水平初始平稳趋势、高水平初始波动趋势及低水平稳定趋势。不同PPV轨迹患者IDH发生风险差异具有统计学意义（P<0.001）。纳入PPV轨迹类别后的Cox比例风险模型性能显著优于基线模型（C指数为0.865和0.742），动态预测模型的时间依赖AUC优于基线模型。 结论 不同PPV轨迹对于CRRT早期发生IDH影响差异具有统计学意义。该研究构建的基于PPV变化轨迹的动态风险预测模型可为危重患者CRRT早期IDH风险的动态评估提供参考，为护理人员早期识别与干预提供依据。

关键词: 重症监护, 连续性肾脏替代疗法, 低血压, 脉压变异, 血流动力学监测

Abstract:

Objective To investigate the predictive role of pulse pressure variation（PPV） trajectories in intra-dialytic hypotension（IDH） during continuous renal replacement therapy（CRRT） in critically ill patients，and to develop a dynamic risk prediction model to support early identification and intervention by nursing staff. Methods Prospective data were collected from 264 CRRT patients in the intensive care unit of a tertiary Grade A hospital in Changzhou，China，from January 2024 to January 2025. The cohort was divided into a training set（70%） and a validation set（30%）. Least absolute shrinkage and selection operator（LASSO） regression was applied to identify independent risk factors of IDH. The joint latent class model（JLCM） identified PPV trajectory trends over time and constructed a dynamic prediction model. Model performance was evaluated using C-index，sensitivity，specificity，and time-dependent area under the receiver operating characteristic curve（AUC）. Results The incidence of IDH was 39.6%. The use of colloid solutions，higher baseline mean arterial pressure（MAP），and higher platelet count were identified as protective factors，while higher body mass index（BMI） was a risk factor. JLCM identified three PPV trajectory categories，including high-level initial stable trend，high-level initial fluctuating trend，and low-level stable trend. Patients with different PPV trajectories exhibited significantly different IDH risk（P<0.001）. The Cox proportional hazards model incorporating PPV trajectory categories demonstrated significantly superior performance compared to the baseline model（C-index 0.865 vs 0.742），and the time-dependent AUC of the dynamic prediction model exceeded that of the baseline model. Conclusion Different PPV trajectories were significantly associated with the occurrence of early IDH during CRRT. The dynamic risk prediction model developed in this study，incorporating pulse pressure variation trajectories，may assist in the dynamic assessment of early intra-dialytic hypotension risk in critically ill patients undergoing CRRT and support early identification and intervention by nursing staff.

Key words: Critical Care, Continuous Renal Replacement Therapy, Hypotension, Pulse Pressure Variation, Hemodynamics