风湿性心脏病患者瓣膜置换术后医院感染风险预测评分模型的构建

doi:10.6040/j.issn.1671-7554.0.2021.1425

摘要/Abstract

摘要： 目的探讨风湿性心脏病(RHD)瓣膜置换术患者医院感染的危险因素及构建风险预测评分模型。方法回顾性收集2018年1月至2019年12月于山东省某三甲综合医院行瓣膜置换术RHD患者的临床信息。应用单因素和多因素Logistic回归分析RHD患者术后感染的独立危险因素,根据比值比(OR)对各个危险因素进行赋分从而构建风险评分模型,通过受试者工作特征曲线(ROC)评价模型的预测效能。结果 329例RHD瓣膜置换术患者的医院感染率为23.40%,感染病原菌以鲍曼不动杆菌(13例)和肺炎克雷伯杆菌(5例)常见。应激性高血糖、术后Braden评分<14分、心包纵隔引流≥7 d、气管插管≥3 d以及糖皮质激素使用≥4 d为RHD瓣膜置换术患者医院感染的独立危险因素,于评分模型中所占分值分别是3、3、3、5、3分,总评分≥6分为感染高风险人群。模型的验证结果:ROC 曲线下面积为0.853(95%CI: 0.805~0.902),灵敏度和特异度分别是84.4%和74.2%。结论 RHD瓣膜置换术患者的医院感染率较高,构建的评分模型能够较好的预测术后感染发生风险。

关键词: 风湿性心脏病, 瓣膜置换术, 医院感染, 危险因素, 评分模型

Abstract: Objective To explore the risk factors of nosocomial infection in rheumatic heart disease(RHD)patients after valve replacement surgery and to establish a risk prediction scoring model. Methods The clinical data of RHD patients who underwent valve replacement surgery in a general hospital in Shandong Province during Jan. 2018 and Dec. 2019 were retrospectively analyzed. The independent risk factors of postoperative infection were analyzed with univariate and multivariate Logistic regression, and a risk prediction scoring model was constructed by assigning a score to each risk factor according to the odds ratio(OR). The predictive efficiency of the model was evaluated with receiver operating characteristic(ROC)curve. Results The nosocomial infection rate was 23.40%, and the primary pathogens of infection were Acinetobacter baumannii(13 cases)and Klebsiella pneumonia(5 cases). Stress hyperglycemia, postoperative Braden score <14, duration of pericardial mediastinal drainage ≥7 d, duration of endotracheal intubation ≥3 d, and glucocorticoid use ≥4 d were independent risk factors for nosocomial infection, and the score of each risk factor in the scoring model was 3, 3, 3, 5 and 3, respectively. Patients with total score ≥6 had high risk of infection. The validation results of the model: the area under the ROC curve was 0.853(95%CI: 0.805-0.902), and the sensitivity and specificity were 84.4% and 74.2%, respectively. Conclusion The incidence of infection in RHD patients undergoing valve replacement surgery is relatively high, and the scoring model can effectively predict risks of postoperative infection.

Key words: Rheumatic heart disease, Valve replacement surgery, Nosocomial infection, Risk factors, Scoring model

中图分类号:

R619+.3

姚雪,卢冉冉,孙淑玲,高翠平,肖茹,王书会. 风湿性心脏病患者瓣膜置换术后医院感染风险预测评分模型的构建[J]. 山东大学学报 (医学版), 2022, 60(6): 90-96.

YAO Xue, LU Ranran, SUN Shuling, GAO Cuiping, XIAO Ru, WANG Shuhui. Establishment of a risk prediction scoring model for nosocomial infection in rheumatic heart disease patients after valve replacement surgery[J]. Journal of Shandong University (Health Sciences), 2022, 60(6): 90-96.

参考文献

[1] Marijon E, Mocumbi A, Narayanan K, et al. Persisting burden and challenges of rheumatic heart disease [J]. Eur Heart J, 2021, 42(34): 3338-3348.
[2] Yang Y, Wang Z, Chen Z, et al. Current status and etiology of valvular heart disease in China: a population-based survey[J]. BMC Cardiovasc Disord, 2021, 21(1): 339.
[3] 林心平, 王建安. 中国心脏瓣膜病介入治疗的现状与进展[J].心电与循环, 2019, 38(5): 353-356.
[4] 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2020概要[J]. 中国循环杂志, 2021, 36(6): 521-545. The Writing Committee of the Report on Cardiovascular Health and Diseases in China. Report on cardiovascular health and diseases burden in China: an updated summary of 2020 [J]. Chinese Circulation Journal, 2021, 36(6): 521-545.
[5] 王欢, 王欣, 谢维泉, 等. 风湿性心脏病心瓣膜置换患者术前免疫功能的变化[J]. 中国胸心血管外科临床杂志, 2000, 7(2): 77-79. WANG Huan, WANG Xin, XIE Weiquan, et al. Changes of preoperative immune function in rheumatic heart disease patients undergoing valve replacement surgery [J]. Chinese Journal of Clinical Thoracic And Cardiovascular Surgery, 2000, 7(2): 77-79.
[6] Lin YZ, Huang JB, Li XW, et al. Clinical comparative analysis of histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid cardioplegia: a 12-year study from a single institution [J]. Exp Ther Med, 2017, 14(3): 2677-2682.
[7] 杨嵩, 张宝, 王翠苹, 等. 心脏人工瓣膜术后真菌性心内膜炎2例报告及治疗策略文献综述[J]. 中国感染控制杂志, 2018, 17(11): 993-997. YANG Song, ZHANG Bao, WANG Cuiping, et al. Fungal endocarditis after heart prosthetic valve surgery: two case report and literature review on treatment strategies [J]. Chinese Journal of Infection Control, 2018, 17(11): 993-997.
[8] 中华人民共和国卫生部. 医院感染诊断标准(试行)[J]. 中华医学杂志, 2001, 81(5): 314-320.
[9] 中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)[J]. 中华结核和呼吸杂志, 2018, 41(4): 255-280.
[10] 魏楠, 王力红, 赵霞, 等. 老年患者导尿管相关尿路感染风险预测评分模型构建与验证[J]. 中国感染控制杂志, 2018, 17(10): 907-912. WEI Nan, WANG Lihong, ZHAO Xia, et al. Establishment and validation of risk prediction scoring model for catheterassociated urinary tract infection in elderly patients [J]. Chinese Journal of Infection Control, 2018, 17(10): 907-912.
[11] 罗雅菲. 急性心肌梗死后心脏破裂的风险预测模型构建与验证[D]. 南昌: 南昌大学, 2021.
[12] Maganti K, Rigolin VH, Sarano ME, et al. Valvular heart disease: diagnosis and management [J]. Mayo Clin Proc, 2010, 85(5): 483-500.
[13] Gelijns AC, Moskowitz AJ, Acker MA, et al. Management practices and major infections after cardiac surgery [J]. J Am Coll Cardiol, 2014, 64(4): 372-381.
[14] OBrien WJ, Gupta K, Itani KMF. Association of Postoperative infection with risk of long-term infection and mortality [J]. JAMA Surg, 2020, 155(1): 61-68.
[15] 王波, 符洪犊, 蒙漫史, 等. 风湿性心脏病术后医院感染患者血清FGF23/Klotho及其与炎症状态和细胞免疫的关系[J]. 中华医院感染学杂志, 2021, 31(19): 3008-3012. WANG Bo, FU Hongdu, MENG Manshi, et al. Serum FGF23/Klotho in patients with nosocomial infection after rheumatic heart disease operation and its relationship with inflammation and cellular immunity [J]. Chinese Journal of Nosocomiology, 2021, 31(19): 3008-3012.
[16] De Marzo V, Dettori S, Nicolini LA, et al. Early infections after successful transcatheter aortic valve replacement are associated with increased short- and long-term mortality: A single-center study [J]. Int J Cardiol, 2021, 332: 48-53. doi:10.1016/j.ijcard.2021.03.065.
[17] 董柱, 曹一秋, 张本, 等. 人工瓣膜置换术后感染的危险因素分析及预防策略[J]. 临床心血管病杂志, 2019, 35(4): 300-305. DONG Zhu, CAO Yiqiu, ZHANG Ben, et al. Analysis of risk factors for infection and prevention strategy after heart valve replacement [J]. Journal of Clinical Cardiology, 2019, 35(4): 300-305.
[18] 王大帅. 成人体外循环术后肺部感染危险因素及病原学分析[D]. 武汉: 华中科技大学, 2019.
[19] Wang J, Wang L, Jia M, et al. Extracorporeal membrane oxygenation-related nosocomial infection after cardiac surgery in adult patients [J]. Braz J Cardiovasc Surg, 2021, 36(6): 743-751.
[20] Pan Y, Cai X, Jing J, et al. Stress hyperglycemia and prognosis of minor ischemic stroke and transient ischemic attack: the chance study(clopidogrel in high-risk patients with acute nondisabling cerebrovascular events)[J]. Stroke, 2017, 48(11): 3006-3011.
[21] Umpierrez GE, Kosiborod M. Inpatient dysglycemia and clinical outcomes: association or causation?[J]. J Diabetes Complications, 2014, 28(4): 427-429.
[22] Kim J, Lee IJ, Kim JH. CT findings of pulmonary tuberculosis and tuberculous pleurisy in diabetes mellitus patients [J]. Diagn Interv Radiol, 2017, 23(2): 112-117.
[23] 胡亚楠, 韩非. 围术期液体管理与应激性高血糖的预防[J].临床麻醉学杂志, 2020, 36(1): 86-89. HU Yanan, HAN Fei. Perioperative fluid management and prevention of stress hyperglycemia [J]. Journal of Clinical Anesthesiology, 2020, 36(1): 86-89.
[24] 孟爱亮, 武莉芳, 孙伯玉, 等. 胰岛素强化治疗对急性心肌梗死伴应激性高血糖患者经皮冠状动脉介入治疗后炎性反应、心功能及主要不良心血管事件的影响[J]. 实用心脑肺血管病杂志, 2021, 29(1): 75-79. MENG Ailiang, WU Lifang, SUN Boyu, et al. Effect of intensive insulin therapy on inflammatory reaction,cardiac function and major adverse cardiovascular events in patients with acute myocardial infarction and stress hyperglycemia after percutaneous coronary intervention [J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2021, 29(1): 75-79.
[25] 张静,陈萍.Braden评估表在泌尿外科手术中的应用效果研究[J].中国医药指南,2014,12(33):235-236.
[26] Moss E, Miller CS, Jensen H, et al. A randomized trial of early versus delayed mediastinal drain removal after cardiac surgery using silastic and conventional tubes[J]. Interact Cardiovasc Thorac Surg, 2013,17(1): 110-115.
[27] Mueller XM, Tinguely F, Tevaearai HT, et al. Impact of duration of chest tube drainage on pain after cardiac surgery[J]. Eur J Cardiothorac Surg, 2000, 18(5): 570-574.
[28] 李雪苹, 陈朝红, 陈艳丽,等. 心脏外科术后医院感染的调查分析及预测概率模型的初步构建[J]. 护理与康复, 2018, 17(10):7-11. LI Xueping, CHEN Zhaohong, CHEN Yanli, et al. Survey and analysis on nosocomial infections after cardiac surgery and primary construction of its prediction model[J]. Journal of Nursing and Rehabilitation, 2018, 17(10):7-11.
[29] Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery society recommendations[J]. JAMA Surg, 2019, 154(8): 755-766.
[30] 顾嘉玺,邵永丰,倪布清,等.Stanford A型主动脉夹层术后血流感染的危险因素分析[J].南京医科大学学报(自然科学版),2020,40(2):245-247.
[31] Schoenle LA, Moore IT, Dudek AM, et al. Exogenous glucocorticoids amplify the costs of infection by reducing resistance and tolerance, but effects are mitigated by co-infection[J]. Proc Biol Sci, 2019, 286(1900):20182913.
[32] Wang H, Zhou J, Guo X, et al. Use of glucocorticoids in the management of immunotherapy-related adverse effects[J]. Thorac Cancer, 2020, 11(10): 3047-3052.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed