皮肤软组织扩张器置入部位感染风险的临床预测模型的构建与验证  

Establishment and validation of a clinical prediction model for infection risk at the placement sites of skin and soft tissue expanders

作　　者：董琛 余州 刘维 刘恒鑫 唐银科 马显杰 Dong Chen;Yu Zhou;Liu Wei;Liu Hengxin;Tang Yinke;Ma Xianjie(Department of Plastic Surgery,the First Affiliated Hospital of Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院整形外科,西安710032

出　　处：《中华烧伤杂志》2021年第9期846-852,共7页Chinese Journal of Burns

基　　金：国家自然科学基金面上项目(81671925,81971851);陕西省科技计划(2018ZDXM-SF-081);西京医院学科助推计划(XJZT19D03)。

摘　　要：目的构建皮肤软组织扩张器(以下简称扩张器)置入部位感染风险的临床预测模型并验证其预测价值。方法采用回顾性观察性研究方法。纳入符合入选标准的2009年1月—2018年12月于空军军医大学第一附属医院整形外科行皮肤软组织扩张术患者2934例,其中男1867例、女1067例,中位年龄18岁,行皮肤软组织扩张术3053例次,置入扩张器4266个。以患者年龄、性别、婚姻状况、民族、入院方式、手术指征、患病时间,有无吸烟史、饮酒史、输血史、基础疾病史、因过敏无法使用头孢菌素类抗生素,单次置入扩张器数量、扩张器额定容积、扩张器首次注水率、扩张器置入部位、麻醉方式、手术时长、有无术后血肿清除为预测变量,以扩张器置入部位感染为结局指标。对数据采用最小绝对值压缩和选择算法(LASSO)回归行单因素分析,筛选影响扩张器置入部位感染的可能危险因素;对单因素分析筛选出的因素行二分类多因素logistic回归分析,筛选影响扩张器置入部位感染的独立危险因素并建立发生扩张器置入部位感染的列线图预测模型。使用C指数和Hosmer-Lemeshow拟合优度检验评价模型的区分度和准确度,采用自助重采样法进行内部验证。结果LASSO回归分析显示,年龄、性别、入院方式、手术指征、患病时间、饮酒史、心脏病史、病毒性肝炎史、高血压史、因过敏无法使用头孢菌素类抗生素、单次置入扩张器数量、扩张器额定容积、扩张器置入部位、术后血肿清除为影响扩张器置入部位感染的可能危险因素(回归系数=-0.005、0.170、0.999、0.054、0.510、-0.003、0.395、-0.218、0.029、0.848、-0.116、0.175、0.085、0.202)。二分类多因素logistic回归分析显示,男性、急诊入院、患病时间≤1年、因过敏无法使用头孢菌素类抗生素、扩张器额定容积≥200 ml且<400 mL或≥400 mL、扩张器置入部位为躯�Objective To establish a clinical prediction model for infection risk at the placement sites of skin and soft tissue expanders(hereinafter termed as expanders)and to validate the predictive value of the model.Methods A retrospective observational study was conducted.Totally 2934 patients who underwent skin and soft tissue dilatation surgery in the Department of Plastic Surgery of the First Affiliated Hospital of Air Force Medical University from January 2009 to December 2018 and met the selection criteria were included.There were 1867 males and 1067 females,with a median age of 18 years.Totally 3053 skin and soft tissue expansion procedures were performed with 4266 expanders implanted.The following indexes were selected as predictor variables,including patients'age,gender,marital status,ethnicity,hospital admission,surgical indication,disease duration,with/without history of smoking,history of drinking,history of blood transfusion,history of underlying diseases,and inability to use cephalosporin antibiotics due to allergy,number of expander in a single placement,rated volume of expander,water injection rate of expander in the first time,placement site of expander,anesthesia method,duration of operation,and with/without postoperative hematoma evacuation,and infection at the placement site of expander as the outcome variable.Univariate analysis of the data was performed using least absolute shrinkage and selection operator(LASSO)regression to screen the potential risk factors affecting infection at the placement sites of expanders,the factors selected by the univariate analysis were subjected to binary multivariate logistic regression analysis to screen the independent risk factors affecting infection at the placement sites of expanders,and a nomogram prediction model for the occurrence of infection at the placement sites of expanders was established.The C index and Hosmer-Lemeshow goodness of fit test were used to evaluate the discrimination and accuracy of the model,respectively,and the bootstrap resampling was u

关 键 词：扩张术 感染 皮肤软组织扩张器 临床预测模型 

分 类 号：R644[医药卫生—外科学] R753.1[医药卫生—临床医学]