剖宫产产后感染发生影响因素及预测模型建立  

Influencing factors of the postpartum infection of puerperas after cesarean section and the predictive model establishment

作　　者：孙书利[1] 岳家伊 王晓莉 肖新燕[1] SUN Shuli;YUE Jiayi;WANG Xiaoli;XIAO Xinyan(The Second People's Hospital of Liaocheng,Shandong Province,252600;People's Hospital of Liaocheng;Dongchangfu District Maternal and Child Health Care Hospital of Liaocheng)

机构地区：[1]山东省聊城市第二人民医院,252600 [2]山东省聊城市人民医院 [3]山东省聊城市东昌府区妇幼保健院

出　　处：《中国计划生育学杂志》2024年第5期1190-1194,共5页Chinese Journal of Family Planning

摘　　要：目的:探究产妇剖宫产产后感染发生情况及影响因素。方法:选取聊城市3所医院2021年1月-2023年1月剖宫产分娩者987例临床资料,行5天随访统计产后感染的发生情况,单因素及多因素logistic回归分析影响剖宫产后感染的因素,构建预测列线图模型。绘制受试者工作特征(ROC)曲线评估模型的区分度;绘制校准曲线评估模型的一致性。结果987例剖宫产产妇中,术后发生感染72例,感染率为7.3%,其中切口感染41例(56.9%)、子宫内膜炎20例(27.8%)、其他感染11例(15.3%);不同年龄、剖宫产次数、白蛋白水平、是否GDM、胎膜早破、第二产程异常转剖宫产者产后感染发生有差异(P<0.05);多因素logistic回归分析,年龄≥30岁、剖宫产≥3次、GDM、胎膜早破、白蛋白水平<35g/L、第二产程异常转剖宫产是产后感染发生的危险因素(P<0.05)。预测剖宫产后发生感染的列线图模型ROC曲线下面积为0.820,区分度较优。且H-L拟合优度检验=8.013,P=0.621,一致性较好。结论:年龄大、剖宫产次数多、白蛋白水平低、GDM、胎膜早破、第二产程异常转剖宫产均是剖宫产后发生感染的危险因素,以此构建的列线图模型具有良好的区分度与一致性,可较好预测剖宫产后感染发生风险,指导临床采取措施干预,从而降低产后感染率。Objective:To explore the incidence of the postpartum infection of puerperas after cesarean section,and to study the influencing factors of the postpartum infection.Methods:The clinical data of 987puerperas who had undergone cesarean section from three hospitals of Liaocheng were selected in this study from January 2021to January 2023.The incidence of the postpartum infections of the puerperas within 5days of follow up after cesarean section was counted.Univariate and multivariate logistic regression were applied to analyze the factors affecting the postpartum infections of the puerperas after cesarean section.A nomogram model was constructed based on these influence factors,and receiver operating characteristic(ROC)curve was drawn to evaluate the discriminability of this model,and the calibration curve was drawn to evaluate the consistency of the model.Results:Among 987puerperas with caesarean section,72 puerperas had postoperative infections,with an infection rate of 7.3%,including 41(56.9%)cases with incision infection,20(27.8%)cases with endometritis and 11(15.3%)cases with other infections.There was significant difference in the proportion of the postpartum infections after cesarean section among the puerperas with different ages,among the puerperas with different number of cesarean sections,among the puerperas with different albumin levels,between the puerperas with and without GDM,between the puerperas with and without premature rupture of membranes,and between the puerperas with and without transferred to cesarean section because of the abnormal second stage of labor(P<0.05).Multivariate logistic regression analysis showed that the age≥30years old,the number of cesarean section≥3times,the GDM,the premature rupture of membranes,the albumin level<35g/L and the transferred to cesarean section because of the abnormal second stage of labor of the puerperas with cesarean section were the risk factors of their postpartum infection(P<0.05).The area under the ROC curve of the nomogram model for predicting the p

关 键 词：剖宫产 产后感染 影响因素 预测模型 

分 类 号：R719.8[医药卫生—妇产科学]