老年冠心病患者冠状动脉旁路移植术后发生肺部感染的影响因素及其风险预测列线图模型构建  

Influencing Factors of Pulmonary Infection after Coronary Artery Bypass Grafting in Elderly Patients with Coronary Heart Disease and Construction of Nomogram Model for Predicting Its Risk

作　　者：徐慧[1] 刘鸿[1] 管玉珍[1] 陆真[1] XU Hui;LIU Hong;GUAN Yuzhen;LU Zhen(Department of Cardiovascular Surgery,Jiangsu Provincial People's Hospital,Nanjing 210029,China)

机构地区：[1]江苏省人民医院心脏大血管外科,江苏省南京市210029

出　　处：《实用心脑肺血管病杂志》2023年第8期48-53,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：江苏省科教能力提升工程项目(ZDXK202230)。

摘　　要：目的 探讨老年冠心病患者冠状动脉旁路移植术(CABG)后发生肺部感染的影响因素,构建其风险预测列线图模型并进行验证。方法 选取2020—2021年于江苏省人民医院行CABG的老年冠心病患者464例为建模集,选取2022年于江苏省人民医院行CABG的老年冠心病患者320例为验证集。收集所有患者的临床资料,根据CABG后住院期间是否发生肺部感染将建模集患者分为肺部感染组和非肺部感染组。老年冠心病患者CABG后发生肺部感染的影响因素采用多因素Logistic回归分析;采用R 4.1.2软件包及rms程序包建立老年冠心病患者CABG后发生肺部感染的风险预测列线图模型;采用Bootstrap法重复抽样1 000次对该列线图模型进行内部验证,计算其一致性指数;采用HosmerLemeshoe拟合优度检验评价该列线图模型的拟合程度;绘制校准曲线以评估该列线图模型预测老年冠心病患者CABG后发生肺部感染的性能;采用ROC曲线分析该列线图模型对老年冠心病患者CABG后发生肺部感染的预测价值。结果建模集464例老年冠心病患者CABG后发生肺部感染69例(14.87%)。两组年龄、术前红细胞分布宽度(RDW)、手术方式、手术时间、输注悬浮红细胞者占比、术后呼吸机通气时间比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、术前RDW、手术方式、手术时间、输注悬浮红细胞、术后呼吸机通气时间是老年冠心病患者CABG后发生肺部感染的独立影响因素(P<0.05)。基于多因素Logistic回归分析结果,构建老年冠心病患者CABG后发生肺部感染的风险预测列线图模型。采用Bootstrap法分别在建模集与验证集中重复抽样1 000次对该列线图模型进行内部验证,结果显示,其一致性指数分别为0.794[95%CI(0.766,0.822)]和0.759[95%CI(0.737,0.782)]。Hosmer-Lemeshoe拟合优度检验结果显示,在建模集和验证集中,该列线图模型拟合较好(χ^(2)=1.294,PObjective To analyze the influencing factors of pulmonary infection after coronary artery bypass grafting(CABG)in elderly patients with coronary heart disease,and to construct and validate the nomogram model for predicting its risk.Methods A total of 464 elderly patients with coronary heart disease who underwent CABG in Jiangsu Provincial People's Hospital from 2020 to 2021 were selected as the modeling set,320 elderly patients with coronary heart disease who underwent CABG in Jiangsu Provincial People's Hospital in 2022 were selected as the validation set.Clinical data of patients were collected,the patients in the modeling set were divided into pulmonary infection group and non-pulmonary infection group based on whether pulmonary infection occurred during hospitalization after CABG.Multivariate Logistic regression analysis method was used to analyze the influencing factors of pulmonary infection after CABG in elderly patients with coronary heart disease.The nomogram model for predicting the risk of pulmonary infection after CABG in elderly patients with coronary heart disease was constructed by the R 4.1.2 software package and rms package.Bootstrap method was used to repeatedly sample 1000 times for internal verification of the nomogram model,and its consistency index(CI)was calculated.Hosmer-Lemeshow goodness of fit test was used to evaluate the fitting degree of the nomogram model.Calibration curve was drawn to evaluate the effectiveness of the nomogram model for predicting pulmonary infection after CABG in elderly patients with coronary heart disease,and the ROC curve was used to analyze the predictive value of the nomogram model for pulmonary infection after CABG in elderly patients with coronary heart disease.Results Among 464 elderly patients with coronary heart disease in the modeling set,69(14.87%)had pulmonary infection.There were significant differences in age,preoperative red cell distribution width(RDW),surgical method,surgical time,proportion of patients suspended red blood cell infusion,and postop

关 键 词：冠心病 冠状动脉旁路移植术 肺部感染 影响因素分析 列线图 

分 类 号：R541.4[医药卫生—心血管疾病]