结直肠癌根治术后合并切口感染病原学及其决策树预测模型构建  

Etiological characteristics of postoperative incision infections in patients undergoing radical resection of colorectal cancer and establishment of predictive decision tree model

作　　者：符国宏[1] 赵宇青 郑杨慈 吴开李 李立新[1] 王连臣[1] FU Guo-hong;ZHAO Yu-qing;ZHENG Yang-ci;WU Kai-li;LI Li-xin;WANG Lian-chen(Hainan Third People's Hospital,Sanya,Hainan 572000,China)

机构地区：[1]三亚中心医院(海南省第三人民医院)普外科,海南三亚572000

出　　处：《中华医院感染学杂志》2023年第21期3270-3274,共5页Chinese Journal of Nosocomiology

基　　金：海南省卫生厅科学研究基金资助项目(20A2W539)。

摘　　要：目的探讨结直肠癌根治术后合并切口感染病原学及构建预测决策树模型.方法选取海南省第三人民医院普外科于2018年1月-2021年10月收治的242例行结直肠癌根治术患者,根据术后合并手术切口感染情况分为感染组45例和非感染组197例.分析感染病原菌分布特点,采用单因素和多因素Logistic回归分析感染的危险因素.基于感染危险因素建立决策树模型,采用受试者工作特征(ROC)曲线分析决策树模型的预测效果.结果45例感染患者共检出62株病原菌,革兰阳性菌22株(35.48%)、革兰阴性菌36株(58.06%)、真菌4株(6.45%).Logistic回归分析显示,糖尿病、TNM分级、出血量、手术时间、血清白蛋白是结直肠癌根治术后合并手术切口感染的危险因素(P<0.05).筛选出3类高危人群:①合并糖尿病,血清白蛋白≤35 g/L,占该节点构成的31.25%;②合并糖尿病,血清白蛋白>35 g/L,占该节点构成的14.29%;③无合并糖尿病,TNM分期≥Ⅲ期,手术时长>150 min,占该节点构成的30.77%.ROC曲线分析显示决策树模型预测感染的曲线下面积为0.806(95%CI:0.729~0.869).结论结直肠癌患者根治术后合并感染病原菌以革兰阴性菌为主,其中糖尿病、TNM分级、出血量、手术时间、血清白蛋白均是手术切口感染的危险因素.决策树模型具有良好的手术切口感染预测价值.OBJECTIVE To explore the etiological characteristics of postoperative incision infections in the patients undergoing radical resection of colorectal cancer and establish the predictive decision tree model.METHODS Totally 242 patients who underwent the radical resection of colorectal cancer in Hainan Third Peoples Hospital from Jan 2018 to Oct 2021 were enrolled in the study and were divided into the infection group with 45 cases and the non-infection group with 197 cases according to the status of postoperative incision infection.The distribution of pathogens causing the infections was analyzed.Univariate analysis and multivariate logistic regression analysis were performed for risk factors for the infections.The decision tree model was established based on the risk factors,and the predictive effect of the decision trce model was analyzed by means of receiver operating characteristic(ROC)curves.RESULTS Totally 62 strains of pathogens were isolated from the 45 patients with the infections,22(35.48%)of which were gram-positive bacteria,36(58.06%)were gram-negative bacteria,and 4(6.45%)were fungi.The logistic regression analysis showed that diabetes mellitus,TNM grade,hemorrhage volume,operation duration and serum albumin were the risk factors for the postoperative incision infections in the patients undergoing radical resection of colorectal cancer(P<0.05).Three types of high-risk groups were screened out:the group complicated with diabetes mellitus and serum albumin no greater than 35 g/L,accounting for 31.25%;the group complicated with diabetes mellitus and serum albumin greater than 35 g/L,accounting for 14.29%;the group without diabetes mellitus,II phase of TNM,operation duration more than 150 min,accounting for 30.77%.ROC curve analysis indicated that the area under curve of the decision tree model was 0.806(95%CI:0.729-0.869)in prediction of the infections.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the colorectal cancer patients with incision infections after radical

关 键 词：结直肠癌 手术切口感染 决策树模型 病原菌 危险因素 诊断价值 

分 类 号：R735.3[医药卫生—肿瘤]