ICU患者气管插管后并发肺内感染情况及其影响因素预测模型的建立与验证

Pulmonary Infection and Establishment and Validation of a Predictive Model for Its Influencing Factors After Tracheal Intubation In ICU Patients

目的分析ICU患者气管插管后并发肺内感染情况,并建立及验证其影响因素预测模型。方法选取2018年2月-2020年12月在ICU行气管插管213例,收集可能影响其气管插管后并发肺内感染的因素,对确诊肺内感染患者行病原菌分离及鉴定,根据肺内感染诊断结果将其分为肺内感染组和非肺内感染组2组并比较上述各因素,采用单因素和多因素Logistic回归分析判断各因素对ICU患者气管插管后并发肺内感染的影响,采用R4.1.2软件的RMS包构建列线图预测模型,以受试者工作特征(ROC)曲线分析该预测模型预测价值,并以计算机模拟充分采样(Bootstrap)法对该预测模型进行内部验证。结果本研究纳入的ICU行气管插管213例中共51例确诊为肺内感染,共培养出病原菌63株,其中革兰阴性菌40株,革兰阳性菌19株,真菌4株。多因素Logistic回归分析结果显示,年龄≥60岁、有吸烟史、有糖尿病史、使用糖皮质激素、气管插管时间>7 d及急诊手术为ICU患者气管插管后并发肺内感染的危险因素(P<0.05,P<0.01),格拉斯哥昏迷量表评分>8分为ICU患者气管插管后并发肺内感染的保护因素(P<0.05)。以此建立的列线图预测模型ROC曲线下面积为0.829,95%CI为0.768,0.889;以Bootstrap法对该预测模型进行内部验证,结果显示平均绝对误差为0.033,该预测模型与理想模型基本拟合。结论ICU患者气管插管后并发肺内感染率较高,以革兰阴性菌感染为主,其并发肺内感染与年龄、吸烟史和糖尿病史等因素有关,以上述因素建立的列线图预测模型具有较高的区分度与准确度。

Objective To analyze the incidence of pulmonary infection after tracheal intubation in ICU patients,and to establish and verify the predictive model of its influencing factors.Methods A total of 213 patients who underwent tracheal intubation in the ICU from February 2018 to December 2020 were selected,and the factors that might affect the complications of pulmonary infection after tracheal intubation were collected.The pathogenic bacteria were isolated and identified in patients with confirmed pulmonary infection.According to the diagnosis results of pulmonary infection,they were divided into two groups:intrapulmonary infection group and non-intrapulmonary infection group,and the above factors were compared.Univariate and multivariate Logistic regression analyses were used to determine the influence of various factors on pulmonary infection after tracheal intubation in ICU patients.The nomogram model was constructed by using the RMS package of R4.1.2 software,the predictive value of the predictive model was analyzed by receiver operating characteristic(ROC)curve,and the predictive model was internally verified by computer simulation sufficient sampling(Bootstrap)method.Results In total,51 cases of 213 ICU patients undergoing tracheal intubation included in this study were diagnosed with intrapulmonary infection.A total of 63 pathogenic bacteria were cultured,including 40 gram-negative bacteria,19 gram-positive bacteria,and 4 fungi.The results of multivariate Logistic regression analysis showed that age≥60 years old,smoking history,history of diabetes,glucocorticoid use,duration of airway intubation>7 days and emergency surgery were the risk factors of pulmonary infection after tracheal intubation in ICU patients(P<0.05,P<0.01).Glasgow Coma Scale score>8 was a protective factor for ICU patients complicated with pulmonary infection after tracheal intubation(P<0.05).The area under the ROC curve of the established nomogram prediction model was 0.829,and the 95%CI was 0.768,0.889.The internal verification of the prediction model by Bootstrap method showed that the mean absolute error was 0.033,and the prediction model basically fitted to the ideal model.Conclusion The incidence of intrapulmonary infection after tracheal intubation in ICU patients is high,mainly due to gram-negative bacterial infection.The intrapulmonary infection is related to factors such as age,smoking history and history of diabetes.The nomogram prediction model established with the above factors has high discrimination and accuracy.