肾癌根治术后切口感染的易感因素调查与预防措施分析

Investigation of Susceptible Factors and Preventive Measures for Incision Infection after Radical Nephrectomy for Renal Cancer

目的探讨肾癌根治术后切口感染的易感因素及预防措施,并建立相关预测模型,探索其预测价值。方法回顾性分析981例我院收治的肾癌根治术后患者的临床资料,根据所选患者是否发生切口感染分为感染组(52例)和未感染组(929例)。分析肾癌根治术后切口感染的单因素,利用多因素Logistic回归探索肾癌根治术后发生切口感染的易感因素,并构建相关预测模型,予以受试者工作特征曲线(ROC)分析预测模型对肾癌根治术后切口感染的预测价值。结果感染组与未感染组是否合并糖尿病、有无术中低体温、手术时间、导尿留置时间及血清降钙素原(PCT)、白细胞介素-6(IL-6)、白蛋白(ALB)及C-反应蛋白(CRP)水平比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,合并糖尿病、术中低体温、手术时间≥3h、导尿留置时间≥7d及血清ALB水平偏低是肾癌根治术后切口感染的独立危险因素(OR=1.848、3.108、2.986、1.672、1.636,P<0.05)。构建相关预测模型:logit(P)=-10.891+合并糖尿病×0.614+术中低体温×1.134+手术时间≥3h×1.094+导尿留置时间≥7d×0.514+血清ALB水平偏低×0.492。ROC曲线分析结果显示,预测模型预测肾癌根治术后切口感染的曲线下面积(AUC)值为0.867,95%CI为0.844~0.887,敏感度为86.54%,特异度为69.97%。结论肾癌根治术后发生切口感染与合并糖尿病、有术中低体温、手术时间≥3h、导尿留置时间≥7d及血清ALB水平偏低有关,据此建立的预测模型对肾癌根治术后发生切口感染的预测价值较高。

Objective To investigate the susceptible factors and preventive measures of incision infection after radical nephrectomy for renal cancer,and establish relevant predictive models to explore their predictive value.Methods The clinical data of 981 patients after radical nephrectomy for renal cancer in our hospital were retrospectively analyzed.They were divided into the infection group(52 cases)and the non-infection group(929 cases)according to whether the selected patients had incision infection.The single factor of incision infection after radical nephrectomy for renal cancer were analyzed.The predisposing factors of incision infection after radical nephrectomy for renal cancery were analyzed by multivariate Logistic regression,and to construct the related prediction model and analyze the predictive value of the prediction model for incision infection after radical nephrectomy for renal cancery by receiver operating characteristic curve(ROC).Results There were significant differences between the infection group and the non-infection group in terms of diabetes,hypothermia,operation time,indwelling time of urethral catheterization and serum levels of procalcitonin(PCT),interleukin-6(IL-6),albumin(ALB),and C-reactive protein(CRP)(P<0.05).Multivariate logistic regression analysis showed that diabetes mellitus,intraoperative hypothermia,operation time≥3h,indwelling catheter time≥7d and low level of serum ALB were independent risk factors for incision infection after radical nephrectomy for renal cancery(OR=1.848,3.108,2.986,1.672,1.636,P<0.05).The predictive model was logit(P)=-10.891+diabetes×0.614+intraoperative hypothermia×1.134+operative time≥3h×1.094+indwelling time≥7d×0.514+low level of serum ALB×0.492.ROC curve analysis showed that the area under the curve(AUC)value of the predictive model for predicting incision infection after radical nephrectomy for renal cancery was 0.867,95%CI was 0.844~0.887,sensitivity was 86.54%,and specificity was 69.97%.Conclusion Incision infection after radical nephrectomy for renal cancery were associated with diabetes mellitus,intraoperative hypothermia,operation time≥3h,indwelling catheter time≥7 d and low level of serum ALB.The predictive model established based on there factors was of high predictive value for incision infection after radical nephrectomy for renal cancery.