摘要
目的:分析老年重症胰腺炎(SAP)患者继发腹腔感染的危险因素,并建立Logistic回归风险预测模型.方法:回顾性选取2019年12月~2021年12月本院收治的的92例老年SAP患者,根据其是否出现腹腔感染将患者分为感染组(24例)和未感染组(68例),收集两组患者临床相关资料,对比两组患者的基本信息、入院时相关血清指标水平等,并对感染患者病原菌分布进行观察.采用二分类Logistic回归分析影响老年重症胰腺炎患者继发腹腔感染的危险因素,并建立风险预测模型,Hosmer-Lemeshow检验评估模型拟合度,ROC检测该模型的预测效能.结果:24例老年重症胰腺炎继发腹腔感染者共分离出42株病原菌,主要以革兰阴性杆菌为主(69.05%),分布前三病原菌为肺炎克雷伯杆菌(21.43%),金黄色葡萄球菌(16.67%),阴沟肠杆菌(14.29%);感染组在肠麻痹时间>4h、发作至就诊时间>6h、有糖尿病、入院APACHEⅡ>11分、AMS>600U/L、有低蛋白血症、机械通气时间>7h、抗生素使用时间>14d中的比例高于未感染组;肠麻痹时间>4h、入院APACHEⅡ>11分、有低蛋白血症、抗生素使用时间>14d均为影响老年胰腺炎患者继发腹腔感染的独立危险因素.建立老年SAP患者继发腹腔感染的Logistic回归风险预测模型:模型预测概率P=1/[1+e(-1.819+-2.563×(肠麻痹时间)+0.687×(APACHEⅡ)+0.689×(低蛋白血症)+-2.236×(抗生素使用时间)],ROC分析显示,Logistic回归风险预测模型预测腹腔感染的AUC为0.720.结论:老年SAP患者继发腹腔感染以革兰阴性菌为主;肠麻痹时间>4h、入院APACHEⅡ>11分、有低氧血症、抗生素使用时间>14d均为影响老年胰腺炎患者继发腹腔感染的独立危险因素,临床医师可对具备以上特征的患者多予以关注,提前采取预防措施,降低腹腔感染率.
Objective To analyze the risk factors of secondary abdominal infection in elderly patients with severe acute pancreatitis(SAP),and construct Logistic regression risk prediction model.Methods A total of 92 elderly patients with SAP admitted to the hospital were retrospectively enrolled between December 2019 and December 2021.According to pres-ence or absence of abdominal infection,they were divided into infection group(24 cases)and non-infection group(68 cases).The clinical data in both groups were collected.The basic information and levels of serum related indexes at admission were compared between the two groups.The distribution of pathogens in infection patients was observed.Risk factors of second-ary abdominal infection were analyzed by binary Logistic regression analysis.The risk prediction model was constructed.The model fit was evaluated by Hosmer-Lemeshow test,and its predictive efficiency was detected by ROC curves.Results In the 24 elderly patients with SAP and abdominal infection,there were 42 strains of pathogens,mainly on Gram-negative bacteria(69.05%)[Klebsiella pneumoniae(21.43%),Staphylococcus aureus(16.67%),Enterobacter cloacae(14.29%)].The propor-tions of cases with intestinal paralysis time>4h,interval from onset to consultation>6h,diabetes mellitus,APACHE II score at admission>11 points,AMS>600U/L,hypoalbuminemia,mechanical ventilation time>7h and antibiotics usage time>14d in infection group were higher than those in non-infection group.Intestinal paralysis time>4h,APACHE II score at admission>11 points,hypoalbuminemia and antibiotics usage time>14d were independent risk factors of secondary abdominal infection.The predictive probability of secondary abdominal infection by Logistic regression risk prediction model was as follow:P=1/[1+e(-1.819+-2.563×(intestinal paralysis time)+0.687×(APACHE II)+0.689×(hypoalbuminemia)+-2.236×(antibiotics usage time)].ROC curves analysis showed that AUC of Logistic regression risk prediction model for predicting abdominal infection was 0.720.Conclusion The
作者
何健强
张向阳
陈旭岩
He Jian-qiang;Zhang Xiang-yang;Chen Xu-yan(Tsinghua Changgung Hospital,Tsinghua University,Beijing 102218,China)
出处
《湖南师范大学学报（医学版）》
2022年第3期100-104,共5页
Journal of Hunan Normal University(Medical Sciences)
关键词
重症胰腺炎
腹腔感染
危险因素
预测模型
severe acute pancreatitis
abdominal infection
risk factor
prediction model
