个体化预测胃肠穿孔患者术后伤口感染的风险列线图模型的建立  

Establishment of a nomogram model for predicting the risk of postoperative wound infection in patients with gastrointestinal perforation

作　　者：林雪蓉[1] 郭思思[1] 周丹[1] 关跃丽 LIN Xuerong;GUO Sisi;ZHOU Dan;GUAN Yueli(Department of Gastrointestinal Surgery,Deyang People's Hospital,Deyang Sichuan 618000,China)

机构地区：[1]德阳市人民医院胃肠外科,四川德阳618000

出　　处：《中国感染与化疗杂志》2021年第6期669-674,共6页Chinese Journal of Infection and Chemotherapy

基　　金：四川省卫生健康委科技项目(18PJ288)。

摘　　要：目的探讨胃肠穿孔患者术后发生伤口感染的危险因素,并构建个体化预测胃肠穿孔患者术后伤口感染的列线图模型。方法回顾性分析2017年2月—2019年12月德阳市人民医院胃肠外科170例行胃肠穿孔手术治疗患者的相关临床资料,单因素分析筛选术后发生伤口感染的相关因素,logistic多因素回归分析发生伤口感染的独立危险因素,并建立个体化预测胃肠穿孔患者术后伤口感染的列线图模型。结果手术时长≥2 h(OR=3.317,95%CI:1.272~8.649)、手术切口未冲洗(OR=6.129,95%CI:1.197~19.595)、体重指数≥24 kg/m^(2)(OR=2.659,95%CI:0.939~7.529)、术前未使用抗生素(OR=5.430,95%CI:1.702~17.328)以及术中切口延长(OR=2.977,95%CI:1.098~8.074)是胃肠穿孔患者术后发生伤口感染的独立危险因素,基于此5个独立危险因素构建预测胃肠穿孔患者术后发生伤口感染的列线图模型,并验证该模型精确度,预测值几乎与实际值相同,一致性指数(C-index)达到0.834(95%CI:0.816~0.852),表明该模型精确度较好。结论手术时长≥2 h、手术切口未冲洗、体重指数≥24 kg/m^(2)、术前未使用抗生素以及术中切口延长是胃肠穿孔患者术后发生伤口感染的独立危险因素,风险预测列线图模型区分度和精确度较好,有一定的临床应用价值。Objective To investigate the risk factors of postoperative wound infection in patients with gastrointestinal perforation and construct a nomogram model for predicting the risk of postoperative wound infection in patients with gastrointestinal perforation.Methods The clinical data of 170 patients with gastrointestinal perforation from February 2017 to December 2019 were retrospectively analyzed.The relevant factors of postoperative wound infection were screened by univariate analysis.The independent risk factors of wound infection were tested by multivariate logistic regression analysis.A nomogram model for predicting the risk of postoperative wound infection in patients with gastrointestinal perforation was established successfully.Results Operation time≥2 h(OR=3.317,95%CI:1.272-8.649),no surgical incision irrigation(OR=6.129,95%CI:1.197-19.595),body mass index≥24 kg/m^(2)(OR=2.659,95%CI:0.939-7.529),no preoperative antibiotic(OR=5.430,95%CI:1.702-17.328)and intraoperative incision extension(OR=2.977,95%CI:1.098-8.074)were independent risk factors for postoperative wound infection in patients with gastrointestinal perforation.A nomogram model was constructed based on these five independent risk factors for predicting the risk of postoperative wound infection in patients with gastrointestinal perforation.The accuracy of the model was verified.The predicted value was almost the same as the actual observed value.The C-index was 0.834(95%CI:0.816-0.852),indicating satisfactory accuracy of the model.Conclusions Operation time≥2 h,no surgical incision irrigation,body mass index≥24 kg/m^(2),no preoperative antibiotic,and incision extension are independent risk factors for postoperative wound infection in patients with gastrointestinal perforation.The risk prediction nomogram model established in this study is promising in clinical setting for its good discrimination and accuracy.

关 键 词：胃肠穿孔 伤口感染 危险因素 列线图模型 

分 类 号：R656[医药卫生—外科学]