摘要
目的分析单孔腹腔镜下肠套叠复位术后医院感染的影响因素并构建列线图预测模型。方法收集2020年11月—2022年10月于本院行单孔腹腔镜下肠套叠复位术的105例患儿的临床资料,根据术后是否出现医院感染分为感染组(n=24)和非感染组(n=81)两组。通过受试者工作特征(ROC)曲线分析各因素的最佳截断值;采用logistic多元回归模型分析单孔腹腔镜下肠套叠复位术后医院感染的独立危险因素;构建预测单孔腹腔镜下肠套叠复位术后医院感染的列线图模型,采用校正曲线对列线图模型进行内部验证,采用决策曲线评估列线图模型的预测效能。结果感染组住院时间、手术时间、hs-CRP、TNF-α、PCT、PTX3水平均高于非感染组(P<0.05);年龄以及预防性使用抗生素比例低于非感染组(P<0.05)。ROC曲线分析结果显示:年龄、住院时间、手术时间、hs-CRP、TNF-α、PCT、PTX3的AUC值分别为0.614、0.892、0.802、0.914、0.766、0.825、0.738;最佳截断值分别为1岁、9 d、128 min、34.5 mg/L、223.5μg/ml、26.51 ng/ml、1.95 ng/ml。年龄(≤1岁)、hs-CRP(>34.5 mg/L)、TNF-α(>223.5μg/ml)、PCT(>26.51 ng/ml)、PTX3(>1.95 ng/ml)是单孔腹腔镜下肠套叠复位术后医院感染的独立危险因素。内部验证结果显示,预测单孔腹腔镜下肠套叠复位术后医院感染的C-index为0.819(95%CI:0.744~0.927)。观测值与预测值之间保持较好一致性。列线图模型预测单孔腹腔镜下肠套叠复位术后医院感染的阈值大于0.17,列线图模型提供的临床净收益均高于年龄、hs-CRP、TNF-α、PCT、PTX3。结论本研究基于年龄、hs-CRP、TNF-α、PCT、PTX3,构建了预测单孔腹腔镜下肠套叠复位术后医院感染的列线图模型,该模型对单孔腹腔镜下肠套叠复位术后医院感染的预测价值较好,可用于识别单孔腹腔镜下肠套叠复位术后医院感染的高危患儿。
Objective To analyze the influencing factors of nosocomial infection after single-hole laparoscopic intussusception reduction and to construct a line graph prediction model.Methods The clinical data of 105 patients underwent single hole laparoscopic intussusception reduction in our hospital from November 2020 to October 2022 were collected for analysis.According to whether nosocomial infection occurred after surgery,the patients were divided into infected group(n=24)and non-infected group(n=81).The optimal cut-off values of each factor were analyzed by receiver operating characteristic(ROC)curve.Multiple logistic regression model was used to analyze the independent risk factors of nosocomial infection after single-hole laparoscopic intussusception reduction.A line graph model was constructed to predict nosocomial infection after single-hole laparoscopic intussusception reduction.The correction curve was used to verify the line graph model internally,and the decision curve was used to evaluate the prediction efficiency of the line graph model.Results The levels of hospital stay,operation time,hs-CRP,TNF-α,PCT and PTX3 in infected group were higher than those in non-infected group(P<0.05).Age and proportion of prophylactic antibiotic use in infected group were lower than those in non-infected group(P<0.05).ROC curve analysis results showed that the AUC values of age,hospital stay,operation time,hs-CRP,TNF-α,PCT and PTX3 were 0.614,0.892,0.802,0.914,0.766,0.825 and 0.738,respectively.The optimal cut-off values were 1 year,9 days,128 min,34.5 mg/L,223.5μg/ml,26.51 ng/ml and 1.95 ng/ml,respectively.Age(≤1 year old),hs-CRP(>34.5 mg/L),TNF-α(>223.5μg/ml),PCT(>26.51 ng/ml),PTX3(>1.95 ng/ml)were independent risk factors for nosocomial infection after single-hole laparoscopic intussusception reduction.Internal validation results showed that the C-index predicting nosocomial infection after single-port laparoscopic intussusception reduction was 0.819(95%CI:0.744~0.927).There is a good agreement between the observed a
作者
赵凯
吕闯
段永福
赵成鹏
Zhao Kai;Lv Chuang;Duan Yongfu;Zhao Chengpeng(Nanyang central hospital,Nanyang,Henan,473000,China)
出处
《齐齐哈尔医学院学报》
2023年第12期1111-1115,共5页
Journal of Qiqihar Medical University
关键词
单孔腹腔镜下肠套叠复位术
术后医院感染
危险因素
列线图预测模型
Single-hole laparoscopic intussusception reduction
Postoperative nosocomial infection
Risk factors
Line graph prediction model
