肠梗阻术后切口感染危险因素及预测模型构建

Risk factors for incision infection after intestinal obstruction surgery and construction of prediction model

目的探讨肠梗阻术后切口感染危险因素,构建预测模型。方法选择2018年1月-2021年4月河北医科大学第二医院收治的行急诊手术治疗的204例肠梗阻患者作为研究对象,收集患者一般资料及术后切口感染发生情况,对感染患者进行病原学检测,采用Logistic回归方程分析切口感染的危险因素,根据风险值确定回归模型,采用似然比及拟合优度检验模型效果,采用受试者工作特征曲线分析模型预测切口感染发生的价值。结果共38例出现术后切口感染,感染率为18.63%;38例感染患者切口分泌物培养分离35株菌株,以大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌为主。多因素分析显示,年龄≥65岁、白蛋白<28 g/L、手术时间≥2 h是肠梗阻患者急诊手术术后切口感染的独立危险因素(P<0.05)。根据风险值建立回归方程,采用Hosmer-Lemeshow检验方程拟合优度,P=0.290,拟合优度良好,根据预测概率模型计算患者的预测概率,绘制ROC曲线,曲线下面积为0.786,约登指数最大时的截点值为-0.753,此时敏感度、特异度分别为84.21%、66.87%。结论急性肠梗阻患者急诊手术术后切口感染发生率较高,建立风险模型可较好的评估感染风险,为早期展开监测及实施预防性措施提供参考。

OBJECTIVE To investigate the risk factors for incision infection after intestinal obstruction surgery,and construct a prediction model.METHODS A total of 204 patients with intestinal obstruction who underwent emergency surgery in the Second Hospital of Hebei Medical University between Jan 2018 and Apr 2021 were recruited as the research subjects.Their general data and the incidence of postoperative incision infection were collected.Pathogenic detection was performed on the infected patients.Logistic regression analysis was used to analyze the risk factors for the incision infection.The regression model was determined according to the risk value,and its effect was verified by test of goodness of fit.The receiver operating characteristic curve was used to analyze the value of this prediction model for incision infection.RESULTS Incision infection occurred in 38 patients after surgery,with an infection rate of 18.63%,and 35 strains were isolated from them,which mainly included Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae and Staphylococcus aureus.Univariate analysis and multivariate analysis showed that age≥65,albumin level<28 g/L and operation time≥2 h were independent risk factors for incision infection in patients with intestinal obstruction after emergency surgery(P<0.05).Regression equation was established according to the value at risk,and Hosmer-Lemeshow test showed good goodness of fit,P=0.290.The ROC curve showed that the area under the curve of this model was 0.786.The cut-off value was-0.753 when Youden index was the largest,and the sensitivity and specificity were 84.21%and 66.87%,respectively.CONCLUSION Patients with acute intestinal obstruction have a higher incidence of incision infection after emergency surgery.The risk model can evaluate the risk of infection efficiently,thereby providing reference for early monitoring and prevention.