造口回纳术后切口感染危险因素分析及预测模型构建  

Analysis of risk factors for surgical site infection after stoma reversal and construction of a prediction model

作　　者：李思若 王飞霞[1] 李卫珍[1] 潘喆[1] 应玲玲 李璐[1] 李霞[1] Li Siruo;Wang Feixia;Li Weizhen;Pan Zhe;Ying Lingling;Li Lu;Li Xia(The First Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou Zhejiang 310003,China)

机构地区：[1]浙江大学医学院附属第一医院,浙江杭州310003

出　　处：《护理与康复》2024年第12期7-13,共7页Journal of Nursing and Rehabilitation

基　　金：浙江省中医药科技计划项目,编号2024ZL542。

摘　　要：目的研究造口回纳术后切口感染的现状并对危险因素进行探讨,构建风险预测模型。方法本研究为前瞻性队列研究,招募浙江大学医学院附属第一医院2023年9月至2024年2月行造口回纳术的患者为研究对象,随访30 d。采用多因素logistic回归分析造口回纳术后切口感染的影响因素并构建风险预测模型,应用受试者工作特征曲线、Hosmer-Lemeshow检验和列线图分析模型预测价值。结果310例患者中发生造口回纳术后切口感染有83例,手术切口感染的发生率为26.8%。多因素logistic回归分析结果表明,术前造口周围皮炎、造口术后切口感染史、预防性使用抗生素是造口回纳术后切口感染的影响因素(P<0.05);Logit(P)=-0.890+1.676×造口术后切口感染史+1.208×术前造口周围皮炎-0.948×预防性使用抗生素。受试者工作特征曲线下面积为0.730,约登指数0.412,最佳截断值0.247,模型特异度74.9%,敏感度66.3%。Hosmer-Lemeshow检验,P=0.926。结论造口回纳术后切口感染发生率较高,术前造口周围皮炎、造口术后切口感染史、预防性使用抗生素是造口回纳术后切口感染的独立预测因子,基于上述因素构建的预测模型预测效果较好。Objective To investigate the prevalence and risk factors of surgical site infection following stoma reversal and to develop a prediction model.Methods This was a prospective cohort study enrolling patients who underwent stoma reversal at the First Affiliated Hospital of Zhejiang University School of Medicine from September 2023 to February 2024,with a 30-day follow-up.Multivariate logistic regression was employed to identify risk factors for surgical site infection post-stoma reversal and to develop a predictive model.The model's predictive accuracy was assessed using the receiver operating characteristic(ROC)curve,Hosmer-Lemeshow test,and a nomogram.Results Among 310 patients,83 developed surgical site infection after stoma reversal,with an infection rate of 26.8%.Multivariate logistic regression identified peristomal dermatitis pre-surgery,a history of surgical site infection post-stoma surgery,and prophylactic antibiotic used as independent risk factors for incisional infection following stoma reversal(P<0.05).The logistic regression equation was Logit(P)=-0.890+1.676×(history of surgical site infection post-stoma surgery)+1.208×(peristomal dermatitis pre-surgery)-0.948×(prophylactic antibiotic use).The area under the ROC curve was 0.730,with a Youden index of 0.412 and an optimal cut-off value of 0.247,resulting in a model specificity of 74.9%and sensitivity of 66.3%.The Hosmer-Lemeshow test indicated good model calibration(P=0.926).Conclusion The rate of surgical site infection following stoma reversal is high.Peristomal dermatitis pre-surgery,a history of surgical site infection post-stoma surgery,and prophylactic antibiotic use are significant predictors of surgical site infection post-stoma reversal.The developed on model demonstrates satisfactory prediction performance.

关 键 词：造口回纳 手术切口感染 术后并发症 影响因素 预测模型 

分 类 号：R473.6[医药卫生—护理学]