慢性阻塞性肺疾病病人呼吸机相关性肺炎91例的病原谱及其列线图预测模型  

Pathogen spectrum and nomogram prediction model in 91 cases of ventilator-associated pneumonia in patients with chronic obstructive pulmonary disease

作　　者：罗艳琳[1] 卢豫川 贾钦尧 宋珊[3] 王涛 LUO Yanlin;LU Yuchuan;JIA Qinyao;SONG Shan;WANG Tao(Department of Internal Medicine-Neurology,Nanchong Second People's Hospital,Nanchong,Sichuan 637000,China;Department of Emergency Medicine,Nanchong Second People's Hospital,Nanchong,Sichuan 637000,China;Department of Respiratory Medi-cine and Critical Care,The Affiliated Hospital of North Sichuan Medical College,Nanchong,Si-chuan 637000,China;Department of Respiratory Medicine and Critical Care,University of Chi-nese Academy of Sciences,Shenzhen Hospital,Shenzhen,Guangdong 518106,China)

机构地区：[1]南充市第二人民医院,神经内科,四川南充637000 [2]南充市第二人民医院急诊内科,四川南充637000 [3]川北医学院附属医院呼吸与危重症医学科,四川南充637000 [4]中国科学院大学深圳医院(光明)呼吸与危重症医学科,广东深圳518106

出　　处：《安徽医药》2024年第1期129-133,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的分析慢性阻塞性肺疾病(COPD)病人呼吸机相关性肺炎(VAP)病原菌感染特点,构建列线图预测模型。方法选择2019年1月至2021年12月在南充市第二人民医院接受机械通气治疗的193例慢性阻塞性肺疾病急性加重期(AECOPD)病人,根据有无VAP将病人分为两组,在单因素分析基础上行多因素logistic回归分析,构建列线图预测模型,以ROC曲线分析模型预测价值,并以计算机模拟充分采样(bootstrap)法进行内部验证。结果该研究的193例中共91例(47.15%)病人出现VAP,91例病人中共分离出病原菌108株,其中革兰阴性菌占72.22%,革兰阳性菌占15.74%,真菌占12.04%,单一感染62例,混合感染29例。单因素分析基础上行多因素分析结果显示:年龄≥60岁、气道干预方式为气道切开、合并糖尿病、机械通气时间≥4 d、使用抗菌药物联合用药、使用抑酸剂、有吸烟史及APACHEⅡ评分≥15分为AECOPD病人VAP发生的危险因素(P<0.05)。根据上述因素以R语言建立列线图预测模型,受试者操作特征(ROC)曲线下面积0.84,95%CI为(0.78,0.90),Bootstrap法对列线图进行内部验证,平均绝对误差为0.02,预测曲线与标准曲线基本拟合。结论AECOPD病人VAP发生率较高,主要因感染革兰阴性菌所致,VAP的发生率受病人年龄、气道干预方式、合并糖尿病情况、机械通气时间、糖皮质激素使用情况、抗菌药物联合用药、抑酸剂使用情况、吸烟史及APACHEⅡ评分的影响,以上述因素构建的列线图模型具有较高的区分度与准确度。Objective To analyze the characteristics of pathogen infection of ventilator-associated pneumonia(VAP)in patients with chronic obstructive pulmonary disease(COPD)and to construct a nomogram prediction model.Methods A total of 193 AECOPD pa⁃tients who received mechanical ventilation treatment in the Second People's Hospital of Nanchong City from January 2019 to December 2021 were selected,and the patients were divided into two groups according to the presence or absence of VAP.On the basis of univari⁃ate analysis,multivariate logistic regression analysis was performed to construct the nomogram prediction model,and the predictive val⁃ue of the model was analyzed by ROC curves and internally validated by computer simulation of the full sampling(bootstrap)method.Results A total of 91 patients(47.15%)of the 193 cases in this study developed VAP,and 108 pathogenic bacteria were isolated from the 91 patients,of which 72.22%were gram-negative,15.74%were gram-positive,and 12.04%were fungal,with 62 cases of single in⁃fections and 29 cases of mixed infections.Univariate analysis based on multifactorial analysis showed that age≥60 years,airway inter⁃vention by airway incision,comorbid diabetes mellitus,duration of mechanical ventilation≥4 d,use of antimicrobial drug combina⁃tions,use of acid suppressants,history of smoking and APACHEⅡscore≥15 were risk factors for the development of VAP in patients with AECOPD(P<0.05).According to the above factors to establish the prediction model of the nomogram in R language,the area un⁃der the curve of the subject operating characteristic(ROC)curve was 0.84,and the 95%CI was(0.78,0.90).The bootstrap method was used to internally validate the nomogram,and the results showed that the mean absolute error was 0.02,and the prediction curve was basically fitted to the standard curve.The incidence of VAP in AECOPD patients was high,mainly due to infection with gram-negative bacteria,and the incidence of VAP was affected by the patient's age,mode of airway intervention,como

关 键 词：肺疾病 慢性阻塞性 肺炎 呼吸机相关性 危险因素 细菌感染和真菌病 列线图 预测 

分 类 号：R563.9[医药卫生—呼吸系统]