颅脑损伤昏迷患者术后感染相关因素及Nomogram预测模型构建  

Correlation factors of postoperative infection in coma patients with craniocerebral injury and Nomogram prediction model construction

作　　者：李盼盼 郭洪 马荣花 马建宁 LI Panpan;GUO Hong;MA Ronghua;MA Jianning(Department of Neurosurgery,Hengshui People's Hospital,Hengshui Hebei 053000,China)

机构地区：[1]衡水市人民医院神经外科,河北衡水053000

出　　处：《中国急救复苏与灾害医学杂志》2025年第4期460-465,共6页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省重点研发计划项目任务书(23046510811D)。

摘　　要：目的 分析颅脑损伤昏迷患者术后感染的影响因素,并构建术后感染的Nomogram预测模型。方法 选取2023年1—9月衡水市人民医院195例颅脑损伤昏迷患者,统计术后住院期间的感染发生情况,根据是否发生感染分为感染组(n=71)和未感染组(n=124)。比较两组临床资料,通过Logistic回归、森林图分析颅脑损伤昏迷患者术后感染的因素,根据影响因素构建术后感染的Nomogram预测模型,并对该预测模型进行内部验证。结果 195例颅脑损伤昏迷患者术后感染发生率为36.41%;感染组的年龄、慢性肺部疾病占比、有复合伤占比、脑室外引流占比、手术次数、血清C反应蛋白(CRP)、内皮型一氧化氮合酶(eNOS)、白细胞介素-6(IL-6)、可溶性白细胞2受体(sIL-2R)、降钙素原(PCT)、细胞间黏附分子-1(ICAM-1)、外周血CD64指数高于未感染组,外周血Th1/Th2低于未感染组(P<0.05);Logistic回归、森林图分析显示,复合伤、脑室外引流、手术次数、慢性肺部疾病、血清IL-6、eNOS、sIL-2R、ICAM-1水平、外周血CD64指数、外周血Th1/Th2均为颅脑损伤昏迷患者术后感染的因素(均P<0.05);根据患者术后感染的因素构建Nomogram预测模型,受试者操作特征(ROC)曲线显示该预测颅脑损伤昏迷患者术后感染的曲线下面积(AUC)为0.911(95%CI:0.872~0.950),校准曲线显示该模型与实际观测结果一致性较好,决策曲线(DCA)显示该预测模型具有明显的正向净收益。结论颅脑损伤昏迷患者术后感染受慢性肺部疾病、复合伤、脑室外引流、手术次数、血清IL-6、eNOS、sIL-2R、ICAM-1水平、外周血CD64指数、外周血Th1/Th2因素影响,基于以上因素构建Nomogram预测模型,该预测模型具有良好的预测效能和临床适用性。Objective To analyze the influencing factors of postoperative infection in coma patients with craniocerebral injury and establish a Nomogram model for postoperative infection prediction.Methods A total of 195 cases of coma patients with craniocerebral injury in Hengshui People's Hospital from January to September 2023 were selected to statistically analyze the incidence of infection during postoperative hospitalization,and were divided into infected group(n=71) and uninfected group(n=124) according to whether infection occurred.By comparing the clinical data of the two groups,Logistic regression and forest map were used to analyze the factors of postoperative infection in patients with craniocerebral injury and coma.A Nomogram prediction model for postoperative infection was established based on the influencing factors,and the prediction model was verified internally.Results The incidence of postoperative infection was 36.41% in 195 patients with craniocerebral injury and coma.Age of infection group,proportion of chronic lung disease,proportion of complex injury,proportion of external ventricular drainage,operation frequency,serum C-reactive protein(CRP),endothelial nitric oxide synthase(eNOS),interleukin-6(IL-6),soluble interleukin-2 receptor(sIL-2R),procalcitonin(PCT),intercellular adhesion molecule 1(ICAM-1),peripheral blood CD64 index was higher than that of uninfected group,and the peripheral blood Th1/Th2 was lower than that of uninfected group(P<0.05).Logistic regression and forest map analysis showed that complex injury,external ventricular drainage,operation frequency,chronic lung disease,serum IL-6,eNOS,sIL-2R,ICAM-1 level,peripheral blood CD64 index,peripheral blood Th1/Th2 were all factors of postoperative infection in coma patients with craniocerebrain injury(all P<0.05).To construct a Nomogram prediction model based on the factors of postoperative infection,the receiver operating characteristic(ROC) curve showed that area under the curve(AUC) for predicting postoperative infection in patients with c

关 键 词：颅脑损伤 昏迷 术后感染 NOMOGRAM 预测模型 构建 

分 类 号：R619.3[医药卫生—外科学]