新生儿重症监护病房机械通气早产儿并发呼吸机相关性肺炎预测模型的构建与验证  

Construction and validation of a predictive model for ventilator-associated pneumonia in premature infants undergoing mechanical ventilation in the neonatal intensive care unit

作　　者：郭永琴[1] 豆瑛瑛 李建丽[1] 常瑞敏 郝亚男 Guo Yongqin;Dou Yingying;Li Jianli;Chang Ruimin;Hao Yanan(Department of Neonatology,Changzhi Maternal and Child Health Hospital,Changzhi 046000,China)

机构地区：[1]长治市妇幼保健院新生儿科,长治046000

出　　处：《中国实用护理杂志》2024年第33期2578-2587,共10页Chinese Journal of Practical Nursing

基　　金：山西省卫生健康委科研课题(2021015)。

摘　　要：目的构建新生儿重症监护病房(NICU)机械通气早产儿并发呼吸机相关性肺炎(VAP)的预测模型,并对其临床应用效果进行检验。方法采用横断面研究方法,便利抽样法选取2018年7月至2023年6月入住长治市妇幼保健院NICU行机械通气治疗的740例早产儿为研究对象,采用计算机产生随机数字法按7∶3比例分为建模集(518例)与验证集(222例),根据是否发生VAP将建模集分为VAP组(181例)与非VAP组(337例),使用21项临床特征分析病例危险因素,采用单因素分析筛选预测因子,通过多因素Logistic回归分析机械通气早产儿并发VAP的独立危险因素,应用R软件制作列线图模型。通过验证集数据对列线图模型进行检验。采用受试者工作特征(ROC)曲线、Hosmer-Lemeshow拟合优度检验、校正曲线以及临床决策曲线评估模型的效能以及实用价值。结果VAP组早产儿男88例,女93例,胎龄<34周156例,≥34周25例;非VAP组早产儿男155例,女182例,胎龄<34周196例,≥34周141例。出生体质量(OR=0.114,95%CI 0.044~0.268,P<0.05)、母乳口腔护理(OR=0.124,95%CI 0.057~0.249,P<0.05)为机械通气早产儿并发VAP的保护性因素,出生5 min Apgar评分(OR=2.895,95%CI 1.318~6.419,P<0.05)、机械通气72 h血清前白蛋白(OR=4.837,95%CI 2.643~9.063,P<0.05)、胃内容物反流(OR=6.754,95%CI 3.156~15.240,P<0.05)、机械通气时间(OR=7.784,95%CI 3.491~18.160,P<0.05)为机械通气早产儿并发VAP的独立危险因素。建模集ROC曲线下面积为0.929(95%CI 0.907~0.950,P<0.01),验证集ROC曲线下面积为0.917(95%CI 0.882~0.952,P<0.01),模型区分度良好。通过Bootstrap法抽样500次得出建模集和验证集C指数分别为0.93和0.92,模型有较好的一致性,决策曲线提示预测模型均远离极端曲线,净收益值高,构建的列线图模型预测价值高。结论出生体质量、出生5 min Apgar评分、机械通气时间、母乳口腔护理、机械通气72 h血清前白蛋白、胃内容物反流是机�Objective To construct a prediction model for ventilator-associated pneumonia(VAP)in mechanically ventilated preterm infants in the neonatal intensive care unit(NICU)and to test its clinical effect.Methods This was a cross-sectional study.A total of 740 preterm infants admitted to the NICU for mechanical ventilation from July 2018 to June 2023 were retrospectively selected as the study subjects,and were divided into the modeling set(518 cases)and the validation set(222 cases)according to the ratio of 7∶3 using the computer-generated random number method.The modeling set was divided into the VAP group(181 cases)and the non-VAP group(337 cases)according to whether VAP occured,and 21 clinical characteristics were analyzed,using single factor difference analysis to screen predictive factors,the independent risk factors of VAP in mechanically ventilated preterm infants were determined by multivariate Logistic regression analysis,and the nomogram model was made by R software.Then,the nomogram model was tested by validating the data of the validation set.The receiver operating characteristic(ROC)curve,Hosmer-Lemeshow goodness-of-fit test,calibration curve and clinical decision curve were used to evaluate the efficacy and practical value of the model.Results There were 88 males and 93 females in the VAP group,with 156 cases of gestational age<34 weeks and 25 cases of gestational age≥34 weeks.There were 155 males and 182 females in the non-VAP group,with 196 cases of gestational age<34 weeks and 141 cases of gestational age≥34 weeks.Birth weight(OR=0.114,95%CI 0.044-0.268,P<0.05)and oral care of breast milk(OR=0.124,95%CI 0.0.057-0.249,P<0.05)were protective factors for VAP in mechanically ventilated preterm infants,and Apgar score at 5 min after birth(OR=2.895,95%CI 1.318-6.419,P<0.05),serum prealbumin at 72 h of mechanical ventilation(OR=4.837,95%CI 2.643-9.063,P<0.05),gastric contents reflux(OR=6.754,95%CI 3.156-15.240,P<0.05),and time of mechanical ventilation(OR=7.784,95%CI 3.491-18.160,P<0.05)were independent

关 键 词：肺炎 呼吸机相关性 机械通气 早产儿 风险预测模型 

分 类 号：R722.6[医药卫生—儿科]