急诊老年肋骨骨折术后肺部感染的危险因素分析及预测模型建立  

Risk factor analysis and prediction model development for postoperative pulmonary infection in elderly patients with emergency rib fractures

作　　者：周俊莲[1] 王玉荣 ZHOU Junlian;WANG Yurong(Department of Emergency,the Second Hospital of Tangshan,Tangshan063000,Hebei,China)

机构地区：[1]唐山市第二医院急诊科,河北唐山063000

出　　处：《贵州医科大学学报》2024年第5期774-780,共7页Journal of Guizhou Medical University

基　　金：河北省医学科学研究课题计划指导项目(20211177)。

摘　　要：目的分析急诊老年肋骨骨折术后肺部感染的影响因素,建立预测感染风险的列线图模型。方法采用便利抽样法,选取行外科手术治疗的老年多发性肋骨骨折患者336例,根据是否发生术后肺部感染,分为感染组(n=52)和非感染组(n=284);收集患者临床一般资料[年龄、性别、体质量指数(BMI)、吸烟史及饮酒史、受伤至手术时间、合并症数量、麻醉方式、骨折原因、机械通气时间及肋骨骨折数等]和血清指标数据[WBC、中性粒细胞/淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、全身免疫炎症指数(SII)、中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞(LY)、总胆固醇(TC)、C-反应蛋白(CRP)、尿素氮(BUN)及肌酐(Scr)等];通过多因素logistic回归分析筛查感染的危险因素,建立预测老年肋骨骨折术后肺部感染发生的列线图模型;采用ROC曲线和Hosmer-Lemeshow拟合优度检测模型的区分度和校准度。结果肋骨骨折手术后发生肺部感染的患者52例,占比15.48%,未发生肺部感染的患者284例,占比84.52%;多因素logistic回归分析结果显示,年龄、合并症数量≥3个、WBC升高、SII升高、术后ICU监护、机械通气时间>3 d和肋骨骨折数≥7根为急诊老年肋骨骨折术后肺部感染独立危险因素(P<0.05);AUC为0.957(95%CI为0.893~0.976),敏感度为90.49%,特异性为82.96%;Hosmer-Lemeshow拟合优度检验结果(χ^(2)=2.196,P=0.571)与校准曲线斜率显示一致性良好。结论年龄、合并症数量、WBC、SII、术后ICU监护、机械通气时间和肋骨骨折数等影响因素构建的老年肋骨骨折术后肺部感染风险预测模型具有较好的区分度和校准度。Objective To analyze the risk factors for postoperative pulmonary infection in elderly patients with rib fractures in the emergency department and develop a nomogram prediction model.Methods A total of 336 elderly patients with multiple rib fractures who underwent surgical treatment were consecutively enrolled and divided into an infection group(n=52)and a non-infection group(n=284)based on the occurrence of postoperative pulmonary infection.Demographic and clinical data,including age,gender,body mass index(BMI),smoking history,drinking history,time from injury to surgery,number of complications,anesthesia method,cause of fracture,mechanical ventilation time,number of rib fractures,and serum indicators[white blood cell count(WBC),neutrophil-to-lymphocyteratio(NLR),platelet-to-lymphocyte ratio(PLR),systemic immune-inflammation index(SII),lymphocytes(LY),total cholesterol(TC),C-reactive protein(CRP),blood urea nitrogen(BUN),and serum creatinine(Scr)],were collected.Multivariate logistic regression analysis was performed to identify risk factors for infection,and a nomogram model was constructed to predict the probability of postoperative pulmonary infection in elderly patients with rib fractures.The discrimination and calibration of the model were evaluated using the receiver operating characteristic(ROC)curve and Hosmer-Lemeshow goodness-of-fit test.Results Among the patients who underwent rib fracture surgery,52(15.48%)developed pulmonary infection,while 284(84.52%)did not.Multivariate logistic regression analysis revealed that age,number of complications≥3,elevated WBC,elevated SII,postoperative ICU monitoring,mechanical ventilation time>3 days,and number of rib fractures≥7 were independent risk factors for postoperative pulmonary infection in elderly patients with rib fractures in the emergency department(P<0.05).The area under the ROC curve(AUC)was 0.957(95%CI was 0.893-0.976),with a sensitivity of 90.49%and a specificity of 82.96%.The Hosmer-Lemeshow goodness-of-fit test result(χ^(2)=2.196,P=0.571)was co

关 键 词：肋骨骨折 老年 肺部感染 影响因素 预测模型 

分 类 号：R683.1[医药卫生—骨科学]