广西医学

目的探讨机械通气患者发生静脉血栓栓塞症（VTE）的现状，并基于随机森林模型分析其影响因素。方法收集263例机械通气患者的临床资料，根据VTE的发生情况，将患者分为VTE组和非VTE组，并进行单因素分析。采用随机森林模型对单因素分析中差异具有统计学意义的变量进行重要性排序，使用LASSO分析筛选变量。通过多因素Logistic回归模型分析机械通气患者发生VTE的影响因素。结果 263例患者中，62例患者发生VTE，发生率为23.6%。单因素分析结果显示，两组患者的年龄、住ICU时间、急性生理学与慢性健康状况评价Ⅱ评分、合并高血压情况、肌力、D⁃二聚体水平、使用镇静药情况、使用血管活性药情况、机械通气时长、纤维蛋白原水平比较，差异有统计学意义（P<0.05）。LASSO分析结果显示，当λ值为0.013 5时，误差最小，所对应的影响因素个数为8个。将随机森林模型中重要性排名前8的变量（住ICU时间、机械通气时长、D⁃二聚体水平、年龄、合并高血压情况、肌力、纤维蛋白原水平、使用血管活性药情况）纳入多因素Logistic回归分析，结果显示，年龄、住ICU时间、合并高血压情况是机械通气患者发生VTE的影响因素（P<0.05）。结论机械通气患者VTE的发生率较高，其中年龄≥60岁、住ICU时间≥7 d、合并高血压的机械通气患者发生VTE的风险增加。

Objective To explore the current status of venous thromboembolism (VTE) in patients with mechanical ventilation, and to analyze its influencing factors based on the random forest model. Methods The clinical data of 263 patients with mechanical ventilation were collected, according to the presence of VTE occurrence, patients were assigned to VTE group or non⁃VTE group, and the univariate analysis was conducted. The random forest model was used to perform importance ranking on variables with statistically significant differences in the univariate analysis, and the variables were screened by the LASSO analysis. The multivariate Logistic regression model was employed to analyze the influencing factors for patients with mechanical ventilation suffering from VTE. Results A total of 62 patients suffered from VTE among 263 patients, resulting in an incidence rate of 23.6%. The results of univariate analysis revealed that there were statistically significant differences in age, length of ICU stay, Acute Physiology and Chronic Health Evaluation Ⅱ score, concomitant hypertension, muscle force, D⁃dimer level, use of sedatives, use of vasoactive drug, mechanical ventilation duration, and fibrinogen level (P<0.05). The results of LASSO analysis indicated that when λ value was 0.0135, the error was the smallest, and the corresponding number of influencing factors was 8. The top 8 important variables in the random forest model with respect to length of ICU stay, mechanical ventilation duration, D⁃dimer level, age, concomitant hypertension, muscle force, fibrinogen level, and use of vasoactive drug were enrolled in the multivariate Logistic regression analysis, and the results interpreted that age, length of ICU stay, and concomitant hypertension were the influencing factors for patients with mechanical ventilation suffering from VTE (P<0.05). Conclusion The incidence rate of VTE is relatively high in patients with mechanical ventilation, therein patients with mechanical ventilation aged≥60 years, with length of ICU stay≥7 days, and those with concomitant hypertension have an increased risk of suffering from VTE.