摘要
目的探讨颅脑损伤患者术后并发肺部感染的危险因素,建立预测术后肺部感染发生风险的列线图模型。方法回顾性分析成都市温江区人民医院神经外科自2013年1月至2018年12月行开颅手术治疗的169例颅脑损伤患者的临床资料,比较术后并发肺部感染和无肺部感染患者的临床资料,多因素Logistic回归分析筛选患者术后并发肺部感染的危险因素;应用R语言建立预测肺部感染风险的列线图模型,采用受试者工作特征曲线(ROC)分析列线图模型对颅脑损伤术后并发肺部感染的预测效果。结果169例患者中并发肺部感染74例(43.8%),未并发肺部感染95例(56.2%)。与无肺部感染组比较,肺部感染组患者中开放型颅脑损伤、格拉斯哥昏迷量表(GCS)评分<7分者所占比例较高,美国麻醉医师协会(ASA)分级较高,术后1周内白蛋白水平较低,手术时间较长,有意识障碍、术中输血、使用呼吸机、卧床时间≥4周者所占比例较高,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示GCS评分(OR=0.243,95%CI:0.122~0.497,P=0.000)、ASA分级(OR=3.349,95%CI:2.233~5.021,P=0.000)、意识障碍(OR=3.185,95%CI:1.217~8.334,P=0.018)、使用呼吸机(OR=3.376,95%CI:1.590~7.167,P=0.002)是颅脑损伤患者术后发生肺部感染的独立危险因素。列线图模型显示GCS评分、ASA分级、意识障碍、使用呼吸机4个变量的评分分别为13.7、100.0、38.0、27.5分。列线图模型预测颅脑损伤患者术后肺部感染的一致性指数为0.835。ROC曲线分析显示列线图模型预测颅脑损伤患者术后肺部感染的曲线下面积为0.840(95%CI:0.778~0.901)。结论基于颅脑损伤术后并发肺部感染危险因素构建的预测肺部感染发生风险的列线图模型具有良好的区分度与预测效果,能为医护人员早期识别高风险患者提供参考,从而采取更有针对性的干预措施。
Objective To explore the risk factors of postoperative pulmonary infection in patients with craniocerebral injury and establish a nomogram model to predict the risk of postoperative pulmonary infection after craniocerebral injury.Methods The clinical data of 169 patients with craniocerebral injury,admitted to and underwent craniotomy in our hospital from January 2013 to December 2018,were retrospectively analyzed.The clinical data of patients with postoperative pulmonary infection and without postoperative pulmonary infection were compared.The risk factors of postoperative pulmonary infection were analyzed by multivariate Logistic regression.R language was used to establish a nomogram model to predict the risk of postoperative pulmonary infection after craniocerebral injury.Receiver operating characteristic(ROC)curve was used to explore the prediction efficiency of the nomogram model for pulmonary infection after craniocerebral injury.Results Among the 169 patients,74(43.8%)were complicated with pulmonary infection and 95(56.2%)were not complicated with pulmonary infection.As compared with non-pulmonary infection group,pulmonary infection group had significantly higher percentages of patients with open craniocerebral injury and Glasgow coma scale(GCS)scores<7,significantly higher American Society of Anesthesiologists(ASA)grading,lower albumin level one week after surgery,statistically longer operation time,and significantly higher percentages of patients with conscious disorder,patients accepted intraoperative blood transfusion,patients used breathing machine,and patients stayed in bed for 4 weeks or more(P<0.05).Multivariate Logistic regression analysis showed that GCS scores(OR=0.243,95%CI:0.122-0.497,P=0.000),ASA grading(OR=3.349,95%CI:2.233-5.021,P=0.000),disturbance of consciousness(OR=3.185,95%CI:1.217-8.334,P=0.018),and use of ventilator(OR=3.376,95%CI:1.590-7.167,P=0.002)were independent risk factors for postoperative pulmonary infection in patients with craniocerebral injury.The scores of the nomogram model were 13.7,100.0,38.0 and 27.5 in GCS scores,ASA grading,disturbance of consciousness and use of ventilator,respectively.The consistency index of the nomogram model for predicting postoperative pulmonary infection in patients with craniocerebral injury was 0.835.ROC curve showed that the area under the curve predicted by nomogram model for postoperative pulmonary infection in patients with craniocranial injury was 0.840(95%CI:0.778-0.901).Conclusion Based on the risk factors for pulmonary infection after craniocerebral injury,a nomogram model for predicting the risk of pulmonary infection is established,which has a good differentiation degree and prediction effect,and can provide a reference for medical staff to identify high-risk patients at an early stage,so as to take more targeted intervention measures.
作者
王宇婵
石长青
李文勇
刘淑芸
刘志会
余雪红
Wang Yuchan;Shi Changqing;Li Wenyong;Liu Shuyun;Liu Zhihui;Yu Xuehong(Department of Science and Education,People's Hospital of Wenjiang District,Chengdu 611130,China;Department of Neurosurgery,People's Hospital of Wenjiang District,Chengdu 611130,China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2019年第12期1209-1214,共6页
Chinese Journal of Neuromedicine
基金
四川省卫生健康委员会普及应用项目(18PJ427)。
关键词
颅脑损伤
肺部感染
列线图模型
危险因素
Craniocerebral injury
Pulmonary infection
Nomogram
Risk factor
