基于DynNom动态评分构建老年主动脉瓣置换术后呼吸机相关性肺炎预测模型  

Prediction model of ventilators associated pneumonia after aortic valve replacement in elderly patients was constructed based on DynNom dynamic score

作　　者：陈星 管玉珍 司林杰 CHEN Xing;GUAN Yuzhen;SI Linjie(Department of Cardiac and Major Vascular Surgery,Jiangsu Provincial People′s Hospital,The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210000,China)

机构地区：[1]江苏省人民医院(南京医科大学第一附属医院)心脏大血管外科监护室,江苏南京210000

出　　处：《临床肺科杂志》2025年第5期706-712,共7页Journal of Clinical Pulmonary Medicine

基　　金：国家自然科学基金资助项目(82202402)。

摘　　要：目的探讨老年主动脉瓣置换术后呼吸机相关性肺炎(ventilator associated pneumonia,VAP)的危险因素,并建立老年主动脉瓣置换术后VAP的列线图模型。方法选取2020年1月至2023年4月医院收治的370例老年主动脉瓣置换术患者作为研究对象,根据老年主动脉瓣置换术后VAP的发生情况将患者分为VAP组和无VAP组。收集两组患者的年龄、性别、手术时间、体外循环时间、体质量指数、急诊手术、饮酒史、吸烟史、联用抗菌药物、肺动脉高压、机械通气时间、低蛋白血症、糖尿病、应用抑酸剂及再次插管等资料。采用最小绝对值收缩和筛选算子(least absolute shrinkage and selection operator,Lasso)分析筛选老年主动脉瓣置换术后VAP的预测因素,采用Logistic回归筛选老年主动脉瓣置换术后VAP的危险因素,采用R软件建立老年主动脉瓣置换术后VAP的列线图模型,并对老年主动脉瓣置换术后VAP的列线图模型进行验证。结果370例老年主动脉瓣置换术患者中有71例患者发生VAP,VAP的发生率为19.19%(71/370)。VAP组和无VAP组患者的年龄、性别、手术时间、体质量指数、急诊手术、饮酒史、吸烟史及肺动脉高压等资料差异均无统计学意义(P>0.05),而体外循环时间、联用抗菌药物、机械通气时间、低蛋白血症、糖尿病、应用抑酸剂及再次插管等资料差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,体外循环时间≥120min、联用抗菌药物、机械通气时间≥4d、低蛋白血症、糖尿病、应用抑酸剂及再次插管等是老年主动脉瓣置换术后VAP的危险因素(P<0.05)。基于危险因素建立了老年主动脉瓣置换术后VAP的动态列线图模型,老年主动脉瓣置换术后VAP的列线图模型受试者工作特征(receiver operating characteristic,ROC)曲线下面积是0.748(95%CI:0.682~0.814);校正曲线的预测值与实际值基本拟合;决策曲线显示阈值概率是7%~94%时,列Objective To investigate the risk factors of ventilator associated pneumonia(VAP)in elderly patients after aortic valve replacement and to establish a nomogram model of VAP in elderly patients after aortic valve replacement.Methods A total of 370 elderly patients with aortic valve replacement admitted to the hospital from January 2020 to April 2023 were selected as the study objects.According to the occurrence of VAP after aortic valve replacement,the patients were divided into VAP group and non-VAP group.Data of age,sex,operation time,extracorporeal circulation time,body mass index,emergency operation,drinking history,smoking history,combination of antibiotics,pulmonary hypertension,mechanical ventilation time,hypoproteinemia,diabetes mellitus,application of acid suppressors and re-intubation were collected.The least absolute shrinkage and selection operator(Lasso)was used to analyze and screen the predictors of VAP after aortic valve replacement in elderly patients.Logistic regression was used to screen the risk factors of VAP after elderly aortic valve replacement.R software was used to establish the nomogram model of VAP after elderly aortic valve replacement,and the nomogram model of VAP after elderly aortic valve replacement was verified.Results VAP occurred in 71 of 370 elderly patients with aortic valve replacement,the incidence of VAP was 19.19%(71/370).There were no significant differences in age,sex,operation time,body mass index,emergency operation,drinking history,smoking history and pulmonary hypertension between VAP group and no-VAP group(P>0.05).There were significant differences in cardiopulmonary bypass time,combined use of antibiotics,mechanical ventilation time,hypoproteinemia,diabetes,application of acid suppressors and re-intubation(P<0.05).Logistic regression analysis showed that cardiopulmonary bypass time≥120min,combined use of antibiotics,mechanical ventilation time≥4d,hypoproteinemia,diabetes,application of acid suppressors and re-intubation were risk factors for VAP in elderly pati

关 键 词：老年 主动脉瓣置换术 危险因素 动态列线图模型 

分 类 号：R654.2[医药卫生—外科学]