摘要
目的分析食管癌(EC)患者术后肺部感染病原学特点及影响因素,并构建预测模型。方法选取2019年1月-2021年1月河南省肿瘤医院收治的156例行手术治疗的EC患者,根据术后是否发生肺部感染分为感染组40例和未感染组116例,分析肺部感染患者病原菌分布特征,收集两组患者临床资料,多因素Logistic回归分析EC患者术后肺部感染的危险因素,建立感染预测模型,绘制受试者工作特征(ROC)曲线评估模型预测效果。结果40例EC术后并发肺部感染患者共培养病原菌56株,以肺炎克雷伯菌、铜绿假单胞菌、肺炎链球菌、鲍氏不动杆菌及金黄色葡萄球菌最为多见。多因素Logistic回归分析显示,年龄≥60岁、糖尿病、慢性阻塞性肺疾病、吸烟、手术时间≥4 h、术后置管时间≥7 d及白蛋白<30 g/L为EC患者术后并发肺部感染的独立危险因素(P<0.05)。根据多因素Logistic回归分析筛选出的EC患者术后肺部感染的独立危险因素构建模型,利用ROC曲线对模型进行内部验证,曲线下面积为0.831(95%CI:0.748-0.914),说明模型具有较好的预测价值。结论EC术后肺部感染以革兰阴性菌为主,且年龄≥60岁、糖尿病、慢性阻塞性肺疾病、吸烟、手术时间≥4 h、术后置管时间≥7 d及白蛋白<30 g/L为EC患者术后并发肺部感染的危险因素,以上述因素为基础构建的预测模型对于EC术后肺部感染的风险预测具有指导作用。
OBJECTIVE To analyze the etiological characteristics of postoperative pulmonary infection in esophageal cancer(EC)patients,explore the influencing factors and establish the prediction model.METHODS Totally 156 EC patients who received surgical procedures in Henan Cancer Hospital from Jan 2019 to Jan 2021 were enrolled in the study and divided into the infection group with 40 cases and the no infection group with 116 cases according to the status of postoperative pulmonary infection.The distribution of pathogens isolated from the patients with pulmonary infection was observed,the clinical data were collected from the two groups of patients,multivariate logistic regression analysis was performed for the risk factors for the postoperative pulmonary infection,the prediction model for infection was established,and receiver operating characteristic(ROC)curves were drawn to evaluate the effect of the prediction model.RESULTS Totally 56 strains of pathogens were isolated from the 40 EC patients with postoperative pulmonary infection,among which Klebsiella pneumoniae,Pseudomonas aeruginosa,Streptococcus pneumoniae,Acinetobacter baumannii and Staphylococcus aureus were the most common.Multivariate logistic regression analysis showed that the no less than 60 years of age,diabetes mellitus,chronic obstructive pulmonary disease,smoking,operation duration no less than 4 hours,postoperative catheter indwelling time no less than 7 days and albumin level less than 30 g/L were the independent risk factors for the postoperative pulmonary infection(P<0.05).The model was established based on the independent risk factors that were screened out by the multivariate logistic regression analysis,the model was internally validated by ROC curves,the area under curve was 0.831(95%CI:0.748-0.914),indicating that the model had high predictive value.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated form the EC patients with postoperative pulmonary infection.The no less than 60 years of age,diabetes mellitus,chronic obstructive pulmonary disease,smoking,operation duration no less than 4 hours,postoperative catheter indwelling time no less than 7 days and albumin level less than 30 g/L are the risk factors for the postoperative pulmonary infection.The prediction model that is established based on the above factors plays a guiding role in the risk prediction of postoperative pulmonary infection in the EC patients.
作者
牛玲娟
王玲玲
吕东霞
王亚敏
任梦园
NIU Ling-juan;WANG Ling-ling;LYU Dong-xia;WANG Ya-min;REN Meng-yuan(Zhengzhou Shuqing Medical College,Zhengzhou,Henan 450064,China;不详)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2023年第10期1504-1507,共4页
Chinese Journal of Nosocomiology
基金
河南省社科联项目(SKL-2019604)。
关键词
食管癌
术后感染
病原学
肺部感染
临床特点
危险因素
预测模型
Esophageal cancer
Postoperative infection
Etiology
Pulmonary infection
Clinical characteristic
Riskfactor
Predictionmodel
