胃癌根治术患者腹腔感染危险因素的贝叶斯网络模型分析  

Bayesian network model analysis of risk factors for intra-abdominal infection in patients undergoing radical gastric cancer surgery

作　　者：罗进 燕速[3] 张书勤 邢多 施昊旻 杨惠莲[2] LUO Jin;YAN Su;ZHANG Shuqin;XING Duo;SHI Haomin;YANG Huilian(Department of Public Health,Qinghai University School of Medicine,Xining 810001,China)

机构地区：[1]青海大学医学部公共卫生系,西宁810001 [2]青海大学临床学院,西宁810001 [3]青海大学附属医院胃肠肿瘤外科

出　　处：《中国感染与化疗杂志》2023年第1期20-26,共7页Chinese Journal of Infection and Chemotherapy

摘　　要：目的 探讨胃癌根治术患者腹腔感染的主要危险因素及感染组病原菌分布情况,利用贝叶斯网络模型揭示腹腔感染影响因素的网络关系及影响程度。方法 回顾性收集2015年1月—2021年3月青海省某三甲医院行胃癌根治术患者的病例资料。首先对胃癌根治术患者腹腔感染相关数据进行单因素分析,利用多因素logisitic回归筛选出独立的危险因素,之后采用MMHC算法构建贝叶斯网络模型。结果 共计纳入胃癌根治术患者1 448例,发生腹腔感染169例,腹腔感染发生率为11.67%;胃癌根治术患者发生腹腔感染会延长患者住院时间;多因素logistic回归模型筛选出5个危险因素,分别为年龄、吸烟史、脉管侵犯、手术时长(≥240 min)、引流管数(≥2根);将logistic回归结果当中的5个危险因素纳入到贝叶斯网络模型当中,结果显示与腹腔感染直接相关的因素为年龄、手术时长、留置引流管数、脉管侵犯;高龄、留置较多引流管且脉管侵犯伴较长手术时间胃癌患者根治术后腹腔感染风险最高达0.462。感染组共培养出115株病原菌,其中革兰阴性菌68株(59.13%),病原菌主要为大肠埃希菌31株(26.96%)、肺炎克雷伯菌11株(9.57%)、铜绿假单胞菌10株(8.70%)、表皮葡萄球菌12株(10.43%)、屎肠球菌13株(11.30%)等。结论 胃癌根治术患者腹腔感染主要的危险因素为高龄、吸烟史、脉管侵犯、较长手术时间、留置较多引流管,贝叶斯网络模型在胃癌根治术患者腹腔感染危险因素研究中具有较好运用前景。Objective To explore the main risk factors of intra-abdominal infection and the distribution of pathogenic bacteria in patients undergoing radical gastrectomy for gastric cancer, and to examine the network relationship among and effects of the risk factors of intra-abdominal infection using Bayesian network model. Methods The clinical data were collected retrospectively from the patients undergoing radical gastric cancer surgery in a tertiary hospital in Qinghai from January 2015 to March 2021. Univariate analysis was performed on the variables relevant to intra-abdominal infection. Then the independent risk factors were screened by multivariate logisitic regression. The max-min hill-climbing(MMHC) algorithm was used to construct a Bayesian network model. Results A total of 1 448 patients undergoing radical gastrectomy for gastric cancer were included, of which 169(11.67%)developed intra-abdominal infection. Intra-abdominal infection prolonged the length of hospital stay. Multivariate logistic regression analysis screened out 5 risk factors for intra-abdominal infection: age, smoking history, vascular invasion, operation time(≥240minutes), number of drainage tubes(≥2). These factors were incorporated into the Bayesian network model, which demonstrated that the factors directly associated with intra-abdominal infection were age, operation duration, number of indwelling drainage tubes, and vascular invasion. Combination of older age, more indwellingdrainage tubes, vascular invasion, and longer operation duration made the risk of intra-abdominal infection after radical resection of gastric cancer up to 0.462. Of the 115 pathogenic bacterial strains isolated from patients, 68(59.13%) were Gram-negative bacteria. The top pathogens included E. coli(26.96%, 31/115), Enterococcus faecium(11.30%, 13/115),Staphylococcus epidermidis(10.43%, 12/115), Klebsiella pneumoniae(9.57%, 11/115), and Pseudomonas aeruginosa(8.70%, 10/115). Conclusions Older age, smoking history, vascular invasion, operation time, and more indwelli

关 键 词：胃癌 腹腔感染 危险因素 贝叶斯网络模型 病原菌 

分 类 号：R656[医药卫生—外科学]