喂养不耐受早产儿中心静脉导管相关感染危险因素及风险预测模型  

Risk factors and risk prediction model for central venous catheter-associated infection in premature infants with feeding intolerance

作　　者：赵宏伟[1] 周启立[1] 武彦秋[1] 郭春艳[1] 祁宏亮[1] ZHAO Hong-wei;ZHOU Qi-li;WU Yan-qiu;GUO Chun-yan;QI Hong-liang(Affiliated Hospital of Chengde Medical College,Chengde,Hebei 067000,China)

机构地区：[1]承德医学院附属医院新生儿科,河北承德067000

出　　处：《中华医院感染学杂志》2023年第19期3004-3008,共5页Chinese Journal of Nosocomiology

基　　金：承德市科技计划基金资助项目(202109A045)。

摘　　要：目的分析喂养不耐受(FI)早产儿中心静脉导管相关感染的危险因素,并据此构建风险预测模型。方法回顾性选取2020年1月-2021年6月于承德医学院附属医院接受外周静脉置入中心静脉导管(PICC)治疗的217例FI早产儿为研究对象,分析患儿置管相关感染情况及病原学检验结果;酶联免疫吸附法检测血清高迁移率族蛋白1(HMGB-1)水平,Logistic回归分析影响FI早产儿中心静脉置管相关感染发生的危险因素,据此构建FI早产儿外周静脉置管相关感染的风险预测模型,并对其预测效能进行验证。结果FI早产儿置管相关感染率为9.22%(20/217);共培养分离病原菌38株,其中革兰阳性菌22株占57.89%,革兰阴性菌14株占36.84%,真菌2株占5.26%;感染组血清HMGB-1高于非感染组(P<0.05);导管留置时间和肠外营养时间是FI早产儿中心静脉导管相关感染的危险因素(P<0.05);构建预测模型如下:Logistic(P)=-4.961+0.645×导管留置时间+0.335×肠外营养时间;受试者工作特征(ROC)曲线分析显示,预测模型曲线下面积为0.799,敏感度和特异度分别为82.61%、80.95%。结论FI早产儿中心静脉导管相关感染以革兰阳性菌为主,HMGB-1水平升高;导管留置时间和肠外营养时间是FI早产儿外周静脉置管感染的危险因素;基于以上危险因素构建的风险预测模型具有良好的预测效能。OBJECTIVE To analyze the risk factors for central venous catheter associated infection in premature infants with feeding intolerance(FI),and to construct a risk prediction model accordingly.METHODS A total of 217 premature infants with FI who were treated with PICC in the Affiliated Hospital of Chengde Medical College between Jan.2020 and Jun.2021 were retrospectively selected as the study subjects.The status of PICC-related infection and etiological examination results were analyzed.The level of high mobility group box-1(HMGB-1)was measured by enzyme-linked immunosorbent assay.Logistic regression analysis was performed to identify the independent risk factors for central venous catheter-associated infection in preterm infants with FI.A predictive model for PICC-related infection in premature infants with FI was constructed based on these factors,and its predictive performance was validated.RESULTS The incidence of catheterization-related infection in FI preterm infants was 9.22%(20/217).A total of 38 pathogenic bacteria strains were isolated,of which 22 strains of gram-positive bacteria accounted for 57.89%,14 strains of gram-negative bacteria accounted for 36.84%,and 2 strains of fungi accounted for 5.26%.Serum HMGB-1 level in the infected group was higher than that in the uninfected group(P<0.05).Catheter indwelling time and parenteral nutrition time were risk factors for central venous infection in premature infants with FI(P<0.05).The prediction model was constructed as follows:Logistic(P)=-4.961+0.645 X catheter indwelling time+0.335 X parenteral nutrition time.The receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of the prediction model was O.799,with a sensitivity and specificity of 82.61%and 80.95%,respectively.CONCLUSION PICC-related infections in premature infants with FI were mainly Gram-positive bacteria,and the level of HMGB-1 was elevated.Catheter indwelling time and parenteral nutrition time were risk factors for catheter-assocital infection in preterm i

关 键 词：早产儿 喂养不耐受 中心静脉导管相关 感染 危险因素 列线图 预测模型 

分 类 号：R722[医药卫生—儿科]