鼻中隔手术患者术后感染危险因素及模型构建

Risk factors for postoperative infection in patients undergoing nasal septum surgery and establishment of model

目的探讨鼻中隔手术患者术后感染病原学特点和危险因素及模型构建。方法选取1506例2017年2月-2022年12月于郑州市第七人民医院和郑州大学第一附属医院行鼻中隔手术患者为研究对象,其中术后感染51例为感染组、术后未感染1455例为非感染组,分析术后感染病原学特点,多因素分析术后感染的风险因素并构建危险预测模型。结果1506例鼻中隔手术患者发生术后感染51例,发生率为3.39%;共分离出53株病原菌,以革兰阴性菌为主;年龄≥60岁、手术时间≥3 h、有吸烟史、有糖尿病及C-反应蛋白(CRP)水平高是鼻中隔手术患者术后感染的独立危险因素(P<0.05),依据筛选的独立风险因素构建鼻中隔手术患者术后感染风险预测模型,Hosmer-Lemeshow拟合度检验显示模型拟合的准确度较好(χ^(2)=5.787,P=0.670),校准曲线显示预测概率与实际概率接近,模型具有良好的区分、校准和预测能力,绘制受试者工作特征(ROC)曲线,曲线下面积(AUC)值为0.946,95%CI为0.912~0.980。模型诊断敏感度为88.7%,特异度为90.2%。结论鼻中隔手术患者术后感染的发生率高,病原菌以革兰阴性菌中的肺炎克雷伯菌、铜绿假单胞菌为主,鼻中隔手术患者术后感染的危险因素包括年龄≥60岁、手术时间≥3 h、有吸烟史、有糖尿病及CRP水平高,临床可进行针对性防治以降低鼻中隔手术患者术后感染的发生风险。

OBJECTIVE To explore the etiological characteristics and risk factors for postoperative infection in the patients undergoing nasal septum surgery and establish the model.METHODS A total of 1506 patients who underwent nasal septum surgery in the Seventh People′s Hospital of Zhengzhou City and the First Affiliated Hospital of Zhengzhou University from Feb 2017 to Dec 2022 were recruited as the research subjects,51 of whom had had postoperative infection and were assigned as the infection group,and 1455 did not have postoperative infection and were assigned as the non-infection group.The etiological characteristics of the postoperative infection were analyzed,multivariate analysis was performed for the risk factors for the postoperative infection,and the risk prediction model was established.RESULTS Of the 1506 patients who underwent the nasal septum surgery,51 had postoperative infection,with the incidence 3.39%.Totally 53 strains of pathogens were isolated,among which gram-negative bacteria were dominant.The no less than 60 years of age,operation duration no less than 3 hours,smoking history,diabetes mellitus and high level of C-reactive protein(CRP)were the independent risk factors for the postoperative infection in the nasal septum surgery patients(P<0.05).The risk prediction model for postoperative infection was established based on the screened independent risk factors,Hosmer-Lemeshow test of goodness of fit showed that the fitting accuracy of the model was excellent(χ^(2)=5.787,P=0.670),the calibration curves indicated that the predicted probability approximated to the actual probability,the model had favorable capability of differentiation,calibration and prediction.Receiver operating characteristic(ROC)curve analysis showed that the area under curve(AUC)was 0.946,with 95%CI:0.912-0.980.The sensitivity of the model was 88.7%in diagnosis,the specificity 90.2%.CONCLUSION The incidence of postoperative infection is high among the patients undergoing nasal septum surgery.Klebsiella pneumoniae and Pseudomonas aeruginosa are the predominant species of gram-negative bacteria among the pathogens.The risk factors for the postoperative infection in the nasal septum surgery patients include the no less than 60 years of age,operation duration no less than 3 hours,smoking history,diabetes mellitus and high level of CRP.It is necessary for the hospital to take targeted prevention and treatment measures so as to reduce the risk of postoperative infection in the nasal septum surgery patients.