摘要
目的:建立中老年输尿管腹壁造口后尿路感染的Nomogram预测模型,并对防控机制进行指导.方法:纳入2020年1月至2022年5月在首都医科大学附属北京友谊医院收治的187例中老年输尿管腹壁造口患者.根据术后是否感染将患者分为感染组(56例)和未感染组(131例),采用Logistic回归分析确定中老年输尿管腹壁造口后尿路感染的独立影响因素,并构建Nomogram预测模型.通过受试者工作特征(ROC)曲线和校准曲线验证Nomogram模型的预测效能及临床应用潜力.结果:186例中老年输尿管腹壁造口患者中,术后感染发生率为29.95%(56/187).年龄、抗生素使用、造口袋更换时间、尿液引流不畅、造口周围并发症、基础疾病与感染相关(P<0.05).感染组在年龄、抗生素使用、造口袋更换时间、尿液引流不畅、造口周围并发症、基础疾病方面高于未感染组(P<0.05).两组性别、手术时间、吸烟史、既往手术史、术后疼痛程度、术中体温比较差异均无统计学意义(P>0.05).多因素Logistic回归分析结果显示,年龄、抗生素使用、造口袋更换时间、尿液引流不畅、造口周围并发症、基础疾病是中老年输尿管腹壁造口后尿路感染的独立危险因素(P<0.05).ROC曲线分析显示,Nomogram预测模型中年龄、抗生素使用、造口袋更换时间、尿液引流不畅、造口周围并发症、基础疾病的曲线下面积(AUC)均>0.600,表明该模型具有良好的预测效能.结论:年龄、抗生素使用、造口袋更换时间、尿液引流不畅、造口周围并发症、基础疾病是中老年输尿管腹壁造口后尿路感染的独立影响因素,基于这6个影响因素构建的Nomogram预测模型具有良好的预测效果.
Abstract
Objective:To establish a Nomogram prediction model of urinary tract infection(UTI)after ureteros-tomy in middle-aged and elderly people,and to provide guidance on preventive measures and management strategies.Methods:The study included 187 middle-aged and elderly patients with ureterostomy from January 2020 to May 2022.Patients were divided into infected group(56 cases)and uninfected group(131 cases)according to postopera-tive infection.Lasso-Logistic regression analysis was used to determine the independent influencing factors of urinary tract infection after ureterostomy in middle-aged and elderly people,and a Nomogram prediction model was construct-ed.The predictive efficacy and clinical application potential of Nomogram model were verified by ROC curve and cali-bration curve.Results:In 186 middle-aged and elderly patients with ureterostomy,the incidence of postoperative in-fection was 29.95％(56/187).Age,antibiotic use,replacement time of ostomy bag,poor urine drainage,complica-tions around ostomy and basic diseases were related to infection(P<0.05).The age,antibiotic use,replacement time of ostomy bag,poor urine drainage,complications around ostomy and basic diseases of the observation group were significantly higher than those in the control group(P<0.05).There was no significant difference in sex,operation time,smoking history,previous operation history,postoperative pain[visual analogue scale(VAS)]or intraoperative body temperature between the two groups(P>0.05).Multivariate Logistic regression analysis showed that age,anti-biotic use,replacement time of stoma,poor urine drainage,complications around stoma and basic diseases were inde-pendent risk factors for urinary tract infection after ureterostomy in middle-aged and elderly people(P<0.05).ROC curve analysis showed that the(area under the curve,AUC)values of age,antibiotic use,replacement time of osto-my bag,poor urine drainage,complications around ostomy and basic diseases in Nomogram prediction model were all>0.600,which showed that the model has good prediction efficiency.Conclusion:Age,antibiotic use,change frequency of ostomy bag,urinary drainage obstuction,stoma-related complications,and comorbidities are indepen-dent risk factors of urinary tract infection after ureterostomy in middle-aged and elderly people.Nomogram prediction model based on these six influencing factors has good prediction effect.
维普
万方数据