脑血管外科微创介入治疗破裂动脉瘤术后肺部感染风险预测模型构建及评价

Construction and evaluation of risk prediction model for pulmonary infection after minimally invasive interventional surgery for ruptured aneurysm in department of cerebrovascular surgery

  • 摘要:
    目的 探讨脑血管外科微创介入治疗破裂动脉瘤术后肺部感染的危险因素,构建微创介入治疗术后肺部感染风险预测模型并评价。
    方法 选取2021年1月1日—2023年12月31日山东大学齐鲁医院德州医院脑血管外科行微创介入手术治疗破裂动脉瘤的579例患者为研究对象,根据术后肺部感染情况分为肺部感染组(77例)和无肺部感染组(502例),统计术后肺部感染病原菌分布,运用多因素logistic回归分析构建预测模型,采用拟合优度检验评价模型,受试者工作特征(ROC)曲线评价模型对微创介入治疗术后肺部感染的预测价值。
    结果 579例行微创介入治疗患者发生术后肺部感染率为13.30%(77例),分离革兰阴性菌71株,革兰阳性菌30株,真菌5株。糖尿病史(OR=9.251)、低蛋白血症(OR=8.874)、使用呼吸机≥48 h(OR=7.231)、吸烟(OR=7.158)、术前中性粒细胞升高(OR=2.738)、术前白细胞升高(OR=3.019)是微创介入治疗术后肺部感染的危险因素(P<0.05)。Hosmer-lemeshow拟合优度检验x2=4.318,df=8,P=0.827,模型拟合良好。预测模型ROC曲线下面积为0.953,敏感度为92.20%,特异度为88.40%。
    结论 糖尿病史、低蛋白血症、使用呼吸机≥48 h、吸烟、术前中性粒细胞升高、术前白细胞升高是微创介入治疗术后肺部感染的危险因素。据此构建介入术后肺部感染风险预测模型具有良好预测价值。

     

    Abstract:
    OBJECTIVE  To investigate the risk factors of pulmonary infection after minimally invasive interventional surgery for ruptured aneurysm in the department of cerebrovascular surgery, and to construct and evaluate a risk prediction model for pulmonary infection after minimally invasive interventional surgery.
    METHODS  A total of 579 patients who underwent minimally invasive interventional surgery for ruptured aneurysm at the Department of Cerebrovascular Surgery, Qilu Hospital of Shandong University Dezhou Hospital from Jan. 1, 2021 to Dec. 31, 2023 were enrolled. They were divided into a pulmonary infection group (77 cases) and a non-pulmonary infection group (502 cases) based on postoperative pulmonary infection status. The distribution of pathogenic bacteria causing postoperative pulmonary infection was analyzed. A multivariate logistic regression analysis was applied to construct a prediction model, and the goodness-of-fit test was used to evaluate the model. The receiver operating characteristic (ROC) curve was employed to assess the predictive value of the model for pulmonary infection after minimally invasive interventional surgery.
    RESULTS  Among 579 patients undergoing minimally invasive interventional surgery, the postoperative pulmonary infection rate was 13.30% (77 cases), with 71 strains of gram-negative bacteria, 30 strains of gram-positive bacteria and 5 strains of fungi isolated. History of diabetes (OR=9.251), hypoproteinemia (OR=8.874), duration of ventilation use ≥48 h (OR=7.231), smoking (OR=7.158), elevated preoperative neutrophils (OR=2.738) and elevated preoperative white blood cells (OR=3.019) were identified as risk factors for pulmonary infection after minimally invasive interventional surgery (P<0.05). The Hosmer-Lemeshow goodness-of-fit test yielded x2=4.318, df=8, P=0.827, indicating good model fit. The area under the ROC curve of the prediction model was 0.953, with a sensitivity of 92.20% and specificity of 88.40%.
    CONCLUSIONS  History of diabetes, hypoalbuminemia, duration of ventilator use no less than 48 hours, smoking, elevated preoperative neutrophils and elevated preoperative white blood cells are risk factors for pulmonary infection after minimally invasive interventional surgery. The constructed risk prediction model for pulmonary infection after interventional surgery demonstrates good predictive value.

     

/

返回文章
返回