老年患者腹腔镜胆囊切除术后感染的影响因素分析和列线图模型建立

Discussion on pharmaceutical care based on nomogram model of infection risk after laparoscopic cholecystectomy in elderly patients

目的 分析老年患者腹腔镜胆囊切除术后发生感染的影响因素,并建立列线图模型,为临床药师开展药学服务提供参考。方法 回顾性分析2021年11月至2022年11月普外科行腹腔镜胆囊切除术的367例老年患者的临床资料,使用多因素Logistic回归分析探讨发生术后感染的影响因素,并建立列线图模型。结果 糖尿病史、合并胆囊急性炎症、术前白细胞计数>9.5×10^(9)·L^(-1)和术前白蛋白水平<40 g·L^(-1)是老年患者腹腔镜胆囊切除术后感染的独立影响因素(P <0.05)。以上述4项影响因素构建列线图模型,模型的曲线下面积为0.781,区分度较高。Hosmer-Lemeshow拟合优度检验结果显示模型的一致性较好。结论 糖尿病史、合并胆囊急性炎症、术前白细胞计数>9.5×10^(9)·L^(-1)和术前白蛋白水平<40 g·L^(-1)是老年患者腹腔镜胆囊切除术后感染的影响因素,临床应予以重视,以上述4项影响因素构建的列线图模型具有较高的预测价值和一致性,对临床具有指导意义。

AIM To analyze the risk factors for the occurrence of infection after laparoscopic cholecystectomy in elderly patients,and to build a nomogram model,so as to provide reference for clinical pharmacists to carry out pharmacy services.METHODS Retrospective analysis of clinical data related to 367 elderly patients who underwent laparoscopic cholecystectomy in the department of general surgery from November 2021 to November 2022,and independent risk factors for postoperative infection were screened by using multi-factor logistic regression analysis to establish a nomogram prediction model.RESULTS Diabetes mellitus,acute inflammation of the gallbladder,white blood cell count>9.5*10^9·L^(-1) and albumin level<40 g·L^(-1) were independent risk factors for postoperative infection in elderly patients undergoing LC(P<0.05).Based on the above 4 risk factors,a line graph prediction model was constructed.The area under the working characteristic curve of the subjects for the model was 0.781,with good discrimination.Results of the Hosmer-Lemeshow goodness-of-fit test revealed that the model demonstrated good consistency(χ^(2)=0.959 and P=0.916).CONCLUSION History of diabetes mellitus acute inflammation of the gallbladder,white blood cell count>9.5*10^9·L^(-1) and albumin level<40 g·L^(-1) were risk factors of postoperative infection.Clinical pharmacists should pay attention to the above risk factors.The nomogram model demonstrates good discrimination and consistency,providing valuable guidance for pharmacy services.