结直肠癌手术患者手术部位感染发生因素及预警模型的预测价值分析

Investigation on the occurrence factors of SSI in patients undergoing colorectal cancer surgery and analysis of the effectiveness of early warning model construction

目的分析结直肠癌手术患者术后手术部位感染(SSI)发生因素以及预警模型的预测价值。方法回顾性分析北京积水潭医院2013年10月至2020年10月收治的1500例结直肠癌手术患者的临床资料,按照患者术后感染情况分为A、B两组,A组330例为术后手术部位发生感染,B组1170例为术后手术部位未发生感染。分析A组患者病菌感染情况;对比两组患者的基本资料及检查;分析结直肠癌手术患者SSI危险因素并建立预警模型。结果A组患者检查出病原菌500株,其中大肠埃希菌最多,有200株,其次为金黄色葡萄球菌,有120株;两组患者性别、病程、吸烟史、病理类型、分化程度、肿瘤位置、临床分期、术前放化疗差异无统计学意义(P>0.05);两组患者年龄、体重指数、糖尿病、肠梗阻、肿瘤大小、手术类型、切口大小、切口位置、手术时间、腹腔感染、术后引流时间、白蛋白、护理质量等差异有统计学意义(P<0.05);患者年龄>60岁、体重指数>24 kg/m^(2)、存在糖尿病和肠梗阻、开腹手术、切口大小>15 cm、手术时间>150 min、术后引流时间>9.36 d、白蛋白<32.24 g/L、护理质量<88.74分是影响患者术后SSI的独立危险因素(P<0.05);根据多因素分析得到10个因素,对其进行SSI的预警模型,受试者操作特征曲线分析显示,该模型预警结直肠癌患者术后SSI发生的曲线下面积为0.950,敏感度为84.4%,特异度为95.6%。结论结直肠癌手术患者SSI发生因素较多,病原菌以大肠埃希菌最多,多因素分析后建立预警模型的敏感度较高,针对性地对患者进行预防对降低SSI有重要意义。

Objective To analyze the factors of postoperative surgical site infection(SSI)in colorectal cancer surgery patients and the predictive value of early warning models.Method A retrospective analysis of the clinical data of 1500 patients undergoing colorectal cancer surgery in Beijing Jishuitan Hospital from October 2013 to October 2020,Patients were divided into group A and group B according to postoperative infection.In group A,330 patients had infection at the surgical site after surgery,and 1170 patients in group B had no infection at the surgical site after surgery.Analyze the bacterial infections of patients in group A;Compare the basic information and examinations of the two groups of patients;Analyze the factors of SSI in patients undergoing colorectal cancer surgery and establish an early warning model.Result In the patients of group A,500 strains of pathogenic bacteria were detected,of which Escherichia coli was the most with 200 strains,followed by Staphylococcus aureus with 120 strains;There were no statistically significant differences in gender,disease course,smoking history,pathological type,degree of differentiation,tumor location,clinical stage,and preoperative radiotherapy and chemotherapy in the two groups(P>0.05),and the differences in age,body mass index,diabetes,intestinal obstruction,tumor size,surgical type,incision size,incision location,surgical time,abdominal infection,postoperative drainage time,albumin,and quality of care were statistically significant(P<0.05);The independent risk factors affecting the SSI of patients were age>60 years,body mass index>24 kg/m^(2),presence of diabetes and intestinal obstruction,open surgery,incision size>15 cm,operation time>150 min,postoperative drainage time>9.36 days,albumin<32.24 g/L,and nursing quality<88.74 points(P<0.05);According to the multi-factor analysis,10 factors were obtained,and the SSI warning model was applied to them.ROC curve analysis showed that the AUC of this model for warning colorectal cancer patients after surgery was 0.950,the sensitivity was 84.4%,and the specificity was 95.6%.Conclusion There are many factors that cause SSI in patients undergoing colorectal cancer surgery,and Escherichia coli is the most pathogenic bacteria.The establishment of an early warning model after multi-factor analysis is highly sensitive,and targeted prevention of patients is of great significance to reducing SSI.