目的 探讨心血管外科监护室真菌感染风险预测模型构建及预防策略研究.方法 回顾性分析中国人民解放军空军军医大学第一附属医院2020年5月—2023年8月178例心血管外科监护室患者,其中41例出现真菌感染,137例未发生真菌感染.收集两组临床资料,利用logistic回归模型分析危险因素,经回归方程拟合的概率值构建风险预测模型,并采用Pearson相关系数评估相关性.结果 41例真菌感染患者中,共检出49株真菌,其中29株为白念珠菌,占比高达59.18％.多因素logistic回归显示:二次气管插管(OR值=0.031)、重症病房监护时间(OR值=8.719)、抗菌药物使用时间(OR值=2.785)、急性生理学及慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)(OR值=2.060)、降钙素原(procalcitonin,PCT)(OR值=2.460)、白细胞介素-6(interleutin-6,IL-6)(OR值=1.044)是心血管外科监护室真菌感染的重要影响因素(P<0.05).淋巴细胞计数(lymphocyte count,LYM)(OR值=0.005)、白蛋白(albumin,ALB)(OR值=0.860)是心血管外科监护室真菌感染的保护因素(P<0.05).Pearson相关系数显示,A-PACHE Ⅱ与PCT呈显著性正相关(r=0.383,P<0.001),APACHE Ⅱ与IL-6无显著相关性(r=0.056,P=0.454).受试者工作特征曲线(receiver operating characteristic curve,ROC)分析显示:联合预测评估心血管外科监护室真菌感染的曲线下面积(area under curve,AUC)=0.996,95％CI为0.911～1.000,灵敏度为0.976,特异度为0.985,与Az=0.5相比,有显著差异(P<0.05).Pearson相关系数显示:心血管外科监护室真菌感染情况与二次气管插管、重症病房监护时间、抗菌药物使用时间、APACHEⅡ、PCT、IL-6呈显著性正相关(P<0.05),与LYM、ALB呈显著性负相关(P<0.05).结论 二次气管插管、重症病房监护时间、抗菌药物使用时间、APACHE Ⅱ、PCT、IL-6是心血管外科监护室真菌感染的重要影响因素,LYM、ALB是其保护因素,应注意其相关因素评估,予以针对性预防策略.
Study on risk prediction model and prevention strategy of fungal infection in cardiac surgical ICU
Objective To investigate the construction of risk prediction model and prevention strategy of fungal infection in cardiovascular surgical care unit.Methods A retrospective analysis was performed on 178 patients in the cardiovascular sur-gical care unit of the First Affiliated Hospital of the PLA Air Force Military Medical University from May 2020 to August 2023.Among them,41 had fungal infection and 137 did not.The clinical data of the two groups were collected,the risk fac-tors were analyzed by logistic regression model,the risk prediction model was constructed by the probability value fitted by the regression equation,and the correlation was evaluated by Pearson correlation coefficient.Results Among 41 patients with fungal infection,49 strains were detected,29 of which were Candida albicans,accounting for 59.18％.Multivariate logistic regression shows:Secondary tracheal intubation (OR=0.031),intensive care unit care time (OR=8.719),antibiotic use time (OR=2.785),acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) (OR=2.060),procalcitonin (PCT) (OR=2.460),interleutin-6 (IL-6) (OR=1.044) were important influencing factors of fungal infections in the cardi-ovascular surgical care unit important influencing factors (P<0.05).Lymphocyte count (LYM) (OR=0.005) and albu-min (ALB) (OR=0.860) were protective factors for fungal infection in the CVD (P<0.05).Pearson correlation coefficient showed that there was a significant positive correlation between APACHE Ⅱ and PCT (r=0.383,P<0.001),but no sig-nificant correlation between APACHE Ⅱ and IL-6 (r=0.056,P=0.454).receiver operating characteristic curve (ROC) a-nalysis showed that the area under curve (AUC) of fungal infection in CVD was 0.996,95％CI was 0.911～1.000,sensi-tivity was 0.976,specificity was 0.985,and there were significant differences compared with Az=0.5 (P<0.05).Pearson correlation coefficient showed that fungal infection in CSCU was positively correlated with secondary tracheal intubation,in-tensive care unit care time,antibiotic use time,APACHE Ⅱ,PCT and IL-6 (P<0.05),and negatively correlated with LYM and ALB (P<0.05).Conclusion Secondary tracheal intubation,intensive care unit care time,antimicrobial drug use time,APACHE Ⅱ,PCT,IL-6 are important factors affecting fungal infection in the cardiovascular surgical care unit,LYM and ALB are protective factors,and the relevant factors should be evaluated for targeted prevention strategies.
cardiac surgical care unitfungal infectionintensive care unitrisk factorsforecast
万方数据
维普
