胃肠道或肝胰胆管癌术后病人器官/腔隙手术部位感染的风险预测模型构建与验证  

Construction and validation of risk prediction model for surgical site infection in organ/lacuna of postoperative patients with cancer of gastrointestinal,liver,pancreatic,bile duct

作　　者：许娟[1] 江莹 於恩桥[1] 杨小华[1] XU Juan;JIANG Ying;YU Enqiao;YANG Xiaohua(The First Affiliated Hospital of Soochow University,Jiangsu 215000 China)

机构地区：[1]苏州大学附属第一医院,江苏215000

出　　处：《护理研究》2022年第14期2497-2502,共6页Chinese Nursing Research

摘　　要：目的:分析胃肠道或肝胰胆管癌术后病人器官/腔隙手术部位感染(SSI)发生的危险因素,并构建和验证风险预测模型。方法:选取2017年10月—2020年10月入我院择期行胃肠道或肝胰胆管癌手术的982例病人为研究对象,按照7∶3比例将病人随机分为模型组(687例)和验证组(295例)。通过医院信息系统医疗数据库提取病人临床资料及生化指标,分析病人器官/腔隙SSI发生的危险因素,基于危险因素构建风险预测模型,并对模型进行验证。结果:982例病人中有94例发生器官/腔隙SSI,器官/腔隙SSI发生率为9.6%,其器官/腔隙SSI发生时间为术后4~9 d。多因素Logistic回归分析结果显示,白细胞计数≥12.1×109/L、中性粒细胞/淋巴细胞比值(NLR)≥4.0、总胆红素≥136.2μmol/L、C反应蛋白(CRP)≥13.5 mg/L和平均体温≥38.0℃是器官/腔隙SSI发生的危险因素(P<0.05)。基于以上因素建立的列线图模型在模型组和验证组中预测器官/腔隙SSI发生的受试者工作特征曲线下面积分别为0.754和0.708(P<0.05)。结论:白细胞计数、NLR、总胆红素、CRP和平均体温是器官/腔隙SSI发生的影响因素,其构建的列线图模型对预测器官/腔隙SSI发生有较高的准确性。Objective:To analyze risk factors of surgical site infection(SSI)in organ/lacuna of postoperative patients with cancer of gastrointestinal,liver,pancreatic,bile duct,and to construct and validate a risk prediction model.Methods:A total of 982 patients who were admitted to our hospital for elective operation of cancer of gastrointestinal,liver,pancreatic,bile duct were selected as research subjects from October 2017 to October 2020.According to the ratio of 7∶3,patients were randomly divided into model group(687 cases)and validation group(295 cases).Patient's clinical data and biochemical indicators were extracted from medical database of hospital information system.Risk factors of patient's SSI in organ/lacuna were analyzed.A risk prediction model was constructed based on the risk factors,and the model was verified.Results:94 in 982 patients had SSI in organ/lacuna,the incidence of SSI in organ/lacuna was 9.6%,and the time of occurrence of SSI in organs/lacuna was from 4 to 9 days after operation.The results of multivariate Logistic regression analysis showed that white blood cell count≥12.1×109/L,neutrophil/lymphocyte ratio(NLR)≥4.0,total bilirubin≥136.2μmol/L,C⁃reactive protein(CRP)≥13.5 mg/L and mean body temperature≥38.0℃were risk factors for occurrence of SSI in organ/lacuna(P<0.05).The area under the receiver operating characteristic curve of nomogram model established based on the above factors for predicting occurrence of SSI in organ/lacuna in model group and validation group were 0.754 and 0.708,respectively(P<0.05).Conclusions:White blood cell count,NLR,total bilirubin,CRP and mean body temperature are influencing factors for occurrence of SSI in organ/lacuna,and the nomogram model constructed by them has high accuracy in predicting occurrence of SSI in organ/lacuna.

关 键 词：手术 手术部位感染 影响因素 预测模型 护理 

分 类 号：R473.73[医药卫生—护理学]