老年卒中患者医院获得性肺炎风险的预测  

Predicting the risk of hospital-acquired pneumonia among elderly stroke patients

作　　者：张宁[1] ZHANG Ning(Emergency Department,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院急诊科,北京100050

出　　处：《临床与病理杂志》2022年第12期2931-2937,共7页Journal of Clinical and Pathological Research

摘　　要：目的:分析老年卒中患者发生医院获得性肺炎(hospital-acquired pneumonia,HAP)的危险因素,建立个体化风险预测模型。方法:采用病例对照研究,对首都医科大学附属北京友谊医院2020年收治的120例老年卒中患者的各项临床资料进行分析,探索HAP的独立危险因素,构建预测HAP风险的列线图模型,并进行验证。结果:120例患者中26例发生HAP,发病率为21.67%。危险因素分析显示:合并糖尿病、慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)、吞咽困难、意识障碍、留置胃管、气管切开、持续机械通气是老年卒中患者并发HAP的独立危险因素。受试者工作特征(receiver operating characteristic,ROC)曲线显示:该HAP风险预测模型的曲线下面积(area under the curve,AUC)为0.897(95%CI:0.815~0.980)。校准曲线斜率接近1,Hosmer-Lemeshow拟合优度好(χ^(2)=9.748,P=0.283)。结论:该HAP风险预测模型兼具良好的区分度和准确度,可识别老年卒中患者发生HAP的高风险环节和人群,为院感防控提供依据。Objective: To analyze the risk factors of hospital-acquired pneumonia(HAP) among elderly stroke patients, to and establish and validate the nomogram model for prediction of the risk of HAP. Methods: Independent risk factors of HAP were investigated based on the clinical data of 120 elderly stroke patients admiThed to Beijing Friendship Hospital, Capital Medical University in 2020 by a case-control study. On the heels of risk analysis, a nomogram model predicting individual risk of HAP was constructed and verified. Results: HAP occurred in 26 of 120 patients, with an incidence of 21.67%. The risk factor analysis showed that diabetes, chronic obstructive pulmonary disease(COPD), dysphagia, disturbance of consciousness, indwelling gastric tube, tracheal incision, and lasting mechanical ventilation were the most common independent risk factors of HAP. The receiver operating characteristic(ROC) curve showed that the area under the curve(AUC) of the HAP risk prediction model is 0.897(95%CI 0.815 to 0.980). The slope of the calibration curve was close to 1 and the Hosmer-Lemeshow goodness-of-fit was good(χ^(2)=9.748, P=0.283). Conclusion: The nomogram model has good discrimination and accuracy, which can accurately predict the individual risk of HAP among elderly stroke patients and provide a basis for the prevention and control of hospital infections.

关 键 词：老年卒中患者 医院获得性肺炎 风险预测 列线图 

分 类 号：R563.1[医药卫生—呼吸系统] R743.3[医药卫生—内科学]