外科全麻患者血流感染风险的预测模型建立及验证  

Establishment and verification of a predictive model for the risk of bloodstream infection in surgical patients with general anesthesia

作　　者：朱梦霞 胡鸣颖 许珏凤 ZHU Mengxia;HU Mingying;XU Juefeng(Operating Room of Huashan Hospital Affiliated to FudanUniversity,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院手术室,上海200040

出　　处：《中国实验诊断学》2025年第1期30-34,共5页Chinese Journal of Laboratory Diagnosis

摘　　要：目的构建并验证外科全麻患者血流感染(BSI)风险的预测模型。方法选取2020年1月至2023年4月复旦大学附属华山医院收治的341例外科全麻患者为研究对象,按照7∶3随机分为分为训练集(239例)和验证集(102例)。根据患者术后住院期间是否并发BSI分为BSI组、无BSI组。分析影响外科全麻患者BSI的因素,建立外科全麻患者BSI的预测模型并进行模型的验证及效能评估。结果训练集24例发生BSI,验证集12例发生BSI。36例BSI患者中共检出64株病原菌,其中革兰阴性菌41株(64.06%),以大肠埃希菌为主;革兰阳性菌23株(35.94%),以表皮葡萄球菌为主。Logistic回归分析显示低蛋白血症(OR=4.314,95%CI:1.673~11.125)、静脉置管(OR=3.734,95%CI:1.865~7.476)、住院时间(OR=4.196,95%CI:1.639~10.746)是影响外科全麻患者BSI的危险因素(P<0.05)。以影响因素为预测变量建立列线图预测模型,总分90~288分,对应风险率0.08~0.56。列线图模型显示C-index指数为0.796(95%CI:0.701~0.813),Calibration曲线显示校正曲线趋近于理想曲线(P>0.05)。训练集、验证集ROC曲线显示:列线图模型预测外科全麻患者BSI的灵敏度分别为70.83%、75.00%,特异度分别为90.23%、88.89%,AUC分别为0.854、0.868。结论低蛋白血症、静脉置管、住院时间是与外科全麻患者BSI有关,基于此构建的外科全麻患者BSI风险的预测模型效能良好。Objective To construct and validate a predictive model for the risk of bloodstream infection(BSI)in patients undergoing surgical general anesthesia.Methods 341patients with surgical general anesthesia admitted to our hospital from January 2020to April 2023were selected as the study objects,and were randomly divided into the training set(239cases)and the verification set(102cases)according to 7∶3.Patients were divided into BSI group and no BSI group according to whether they were complicated with BSI during postoperative hospitalization.The factors affecting BSI in surgical patients with general anesthesia were analyzed,and the prediction model of BSI in surgical patients with general anesthesia was established.Results The occurrence of bloodstream infections(BSI)was observed in 24cases within the practice set and 12cases within the verification set.A total of 64strains of pathogenic bacteria were identified in 36BSI patients,with gram-negative strains,predominantly Escherichia coli,accounting for 64.06%and grampositive strains,mainly Staphylococcus epidermidis,accounting for 35.94%.Logistic regression analysis revealed that hypoproteinemia(OR=4.314,95%CI:1.673~11.125),intravenous catheters(OR=3.734,95%CI:1.865~7.476),and length of hospital stay(OR=4.196,95%CI:1.639~10.746)were significant risk factors for BSI among surgical patients under general anesthesia(P<0.05).A nomogram prediction model was established with the influence factors as the predictor variables.The total score was 90~288,and the corresponding risk rate was 0.08~0.56.The Calibration curve showed that C-index is 0.796(95%CI:0.701~0.813).The calibration curve shows that the calibration curve is close to the ideal curve(P>0.05).ROC curves of training set and validation set showed that the sensitivity,specificity and AUC of the nomogram model for predicting BSI in surgical general anesthesia patients were 70.83%and 75.00%,90.23%and 88.89%,and 0.854and 0.868.Conclusion Hypoproteinemia,intravenous catheterization,and length of hospital stay are relate

关 键 词：外科 血流感染 因素 预测模型 

分 类 号：R47[医药卫生—护理学]