体外膜肺氧合相关院内感染的危险因素分析与预测模型构建  

Risk factor analysis and prediction modeling of nosocomial infections associated with extracorporeal membrane lung oxygenation

作　　者：程松 李媛媛 郭宾 李昂[4] Cheng Song;Li Yuan-yuan;Guo Bin;Li An(Department of Public Health,The First Affiliated Hospital of Nanyang University of Higher Medical Sciences,Nanyang 473000,Henan,China;Department of Infection Prevention and Control,,The First Affiliated Hospital of Nanyang University of HigherMedical Sciences,Nanyang 473000,Henan,China;Department of Laboratory Medicine,,The First Affiliated Hospital of NanyangUniversity of Higher Medical Sciences,Nanyang,China;Department of General Surgery,,The First Affiliated Hospital of NanyangUniversity of Higher Medical Sciences,Nanyang 473000,Henan,China)

机构地区：[1]南阳医学高等专科学校第一附属医院公共卫生科,河南南阳473000 [2]南阳医学高等专科学校第一附属医院预防感染与控制科,河南南阳473000 [3]南阳医学高等专科学校第一附属医院检验科,河南南阳473000 [4]南阳医学高等专科学校第一附属医院普通外科,河南南阳473000

出　　处：《四川生理科学杂志》2024年第6期1201-1204,共4页Sichuan Journal of Physiological Sciences

基　　金：南阳市2022年市级科技项目(RKX051)。

摘　　要：目的:探讨体外膜肺氧合(Extracorporeal Membrane Oxygenation,ECMO)治疗患者相关院内感染的危险因素,并建立风险预测模型。方法:回顾性分析2020年12月至2023年6月在我院接受ECMO治疗的153例患者的临床资料。根据术后感染诊断标准,分为感染组(71例)和未感染组(82)例。收集对比两组患者的基线资料和ECMO相关参数。应用多元Logistic回归分析方法研究ECMO病人发生院内感染的独立危险因素并建立预测模型。运用倾向评分匹配法和边际分析法评估院内感染所造成的患者及医院经济损失。结果:153例ECMO患者中71例(46.41%)发生了医院感染。多因素Logistic回归分析结果显示,急性生理与慢性健康评分第II版评分、总住院时间、ECMO运行时间、ECMO撤离前机械通气时间均是ECMO患者医院感染的危险因素(P<0.05)。根据Logistic回归结果建立风险预测模型,经Hosmer-Lemeshow检验模型的拟合度较高(χ^(2)=4.124,P=0.776)。ROC曲线分析结果显示,ECMO相关感染的风险预测模型预测使用ECMO治疗后发生院内感染的AUC为0.911(95%CI(0.852,0.970),P<0.001)。结论:本研究构建的预测模型可作为制定有效措施预防ECMO相关院内感染的参考依据。Objective:To explore the risk factors of nosocomial infections associated with patients treated with Extracorporeal Membrane Oxygenation(ECMO)and establish a risk prediction model.Methods:The clinical data of 153 patients who received ECMO treatment from December 2020 to June 2023 in our hospital were retrospectively analyzed.According to the diagnostic criteria of postoperative infection,they were divided into the infected group(71 cases)and the uninfected group(82)cases.Baseline data and ECMO-related parameters were collected and compared between the two groups.Multiple logistic regression analysis was applied to study the independent risk factors for nosocomial infections in ECMO patients and establish a prediction model.Propensity score matching and marginal analysis were applied to assess the economic losses of patients and hospitals caused by nosocomial infections.Results:Hospital-acquired infections occurred in 71(46.41%)of 153 ECMO patients.The results of multifactorial logistic regression analysis showed that Acute Physiology and Chronic Health Score version II score,total hospitalization time,ECMO running time,and mechanical ventilation time before ECMO evacuation were risk factors for hospital-acquired infections in ECMO patients(P<0.05).A risk prediction model was established based on the results of logistic regression,and the fit of the model was high by the Hosmer-Leme show test(χ^(2)=4.124,P=0.776).The results of the ROC curve analysis showed that the risk prediction model for ECMO-associated infections predicted that the AUC for the occurrence of nosocomial infections after treatment with ECMO was 0.911(95%CI(0.852,0.970),P<0.001).Conclusion:The prediction model constructed in this study can be used as a reference for developing effective measures to prevent ECMO-related nosocomial infections.

关 键 词：体外膜肺氧合 危险因素 预测模型 院内感染 

分 类 号：R181.34[医药卫生—流行病学]