摘要
目的 构建重症肺炎患儿呼吸机相关性肺炎(VAP)发生风险列线图模型。方法 选择2021年3月至2023年3月收治的150例行机械通气治疗的重症肺炎患儿的临床资料进行回顾性研究,将其按7:3以简单随机抽样法分为建模组(105例)和验证组(45例)。分析建模组患儿发生VAP的独立危险因素并构建列线图,以验证组数据对列线图模型进行外部验证。结果 建模组发生VAP 27例;验证组发生VAP 12例。VAP组的机械通气时间≥5 d、插管次数≥2次、使用糖皮质激素、误吸入、脱机失败再插管占比高于非VAP组(P<0.05)。机械通气时间≥5 d、插管次数≥2次、使用糖皮质激素、误吸入、脱机失败再插管是重症肺炎患儿VAP发生的危险因素(P<0.05)。建模组、验证组的C-index分别为0.832、0.897。区分度评价结果显示,建模组曲线下面积(AUC)为0.832,验证组AUC为0.817。结论 根据重症肺炎患儿发生VAP的危险因素构建列线图模型能有效预测VAP发生风险。
Objective To construct a nomogram model for the risk of ventilator associated pneumonia(VAP)in children with severe pneumonia.Methods The clinical data of 150 children with severe pneumonia who underwent mechanical ventilation from March 2021 to March 2023 were retrospectively studied.The children were divided into modeling group(105 cases)and validation group(45 cases)according to 7∶3 by simple random sampling method.The independent risk factors of VAP in the modeling group were analyzed and a nomogram was constructed,external verification of the nomogram model was performed with the validation group data.Results There were 27 cases of VAP in the modeling group;there were 12 cases of VAP in the validation group.The proportions of mechanical ventilation time≥5 d,the number of intubation≥2 times,use of glucocorticoids,accidental inhalation,and re-intubation after weaning failure in the VAP group were higher than those in the non-VAP group(P<0.05).The mechanical ventilation time≥5 d,the number of intubation≥2 times,the use of glucocorticoids,accidental inhalation,and re-intubation after weaning failure were risk factors for VAP in children with severe pneumonia(P<0.05).The C-index of the modeling group and the validation group were 0.832 and 0.897,respectively.The discrimination evaluation results showed that the area under the curve(AUC)of the modeling group was 0.832,and the AUC of the validation group was 0.817.Conclusion Building a nomogram model based on the risk factors of VAP in children with severe pneumonia can effectively predict the risk of VAP.
作者
张先梅
文艳
哈海霞
罗永丽
张艳
ZHANG Xianmei;WEN Yan;HA Haixia;LUO Yongli;ZHANG Yan(Pediatrics Department,Ankang Hospital of Traditional Chinese Medicine,Ankang 725000;Comprehensive Internal Medicine Department,Tuberculosis Hospital of Shaanxi Province,Xi'an 710100,China)
出处
《临床医学研究与实践》
2024年第27期9-13,共5页
Clinical Research and Practice
基金
陕西省重点研发计划项目(No.S2020-YF-YBSF-0128)。
关键词
重症肺炎
呼吸机相关性肺炎
机械通气
列线图
severe pneumonia
ventilator associated pneumonia
mechanical ventilation
nomogram
