骨科老年住院患者医院感染危险因素分析及预测模型构建

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摘要目的探析骨科老年住院患者医院感染的危险因素并构建预测模型。方法选取2015年1月～2018年12月于上海市第六人民医院骨科住院的2114例患者，按照随机数字表法将患者分为建模组和验证组，每组1057例。使用χ2检验和非条件logistic回归分析影响医院感染的危险因素，并根据结果建立老年骨科患者医院感染的预测模型。结果建模组1057例患者中，发生医院感染的有53例。logistic回归分析显示年龄、住院时间、手术时间、手术切口类型、使用导尿插管、患有骨质疏松是骨科住院患者发生医院感染的危险因素（P ＜ 0.05）。构建的预测模型中概率值拟合联合预测的ROC曲线下面积为0.808，敏感性和特异性分别为73.3%和81.2%。并在此基础上建立预测评分模型，建模组和验证组的ROC曲线下面积分别为0.801（95%CI：0.725～0.852）和0.721（95%CI：0.630～0.812）。结论骨科患者的年龄、住院时间、手术时间、手术切口类型、使用导尿插管、患有骨质疏松是其发生医院感染的危险因素，据此构建的预测模型在建模组和验证组均较好的判别效度。

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	左丽丽薛翌蔚

关键词 ：骨科, 医院感染, 危险因素, logistic回归分析, 预测模型

Abstract：Objective To analyze the risk factors of nosocomial infection in orthopedic hospitalized patients and to construct a predictive model. Methods A total of 2114 patients who were admitted to the Department of Orthopedics of Shanghai Sixth People′s Hospital from January 2015 to December 2018 were selected. The patients were divided into the modeling group and the validation group according to the random number table method, with 1057 patients in each group. Chi-square test and unconditional logistic regression were used to analyze the risk factors affecting nosocomial infection, and the predictive model of nosocomial infection in elderly orthopedic patients was established based on the results. Results Among the 1057 patients in the modeling group, 53 cases had nosocomial infection. Logistic regression analysis showed age, hospital stay, operative time, surgical incision type, catheterization, and osteoporosis were risk factors for nosocomial infection in hospitalized orthopedic patients (P < 0.05). The area under the ROC curve of probability value fitting joint prediction in the constructed prediction model was 0.808, and the sensitivity and specificity were 73.3% and 81.2%, respectively. Based on this, a predictive scoring model was established. The area under the ROC curve of the modeling group and the verification group were 0.801 (95%CI: 0.725-0.852) and 0.721 (95%CI: 0.630-0.812), respectively. Conclusion Age, hospital stay, operative time, surgical incision type, catheterization and osteoporosis of orthopedic patients are risk factors for nosocomial infection. The predictive model constructed by this method has good discriminat validity in both the modeling group and the validation group.

Key words： Orthopedics Nosocomial infection Risk factor Logistic regression Predictive model

基金资助:上海市第六人民医院东院院级科学研究基金计划项目（院人才2014032）。

通讯作者: 薛翌蔚（1977.8-），女，副主任护师，上海市第六人民医院东院骨科护士长；研究方向：骨科护理。

引用本文:

左丽丽薛翌蔚. 骨科老年住院患者医院感染危险因素分析及预测模型构建[J]. 中国医药导报, 2020, 17(3): 86-89,97.
ZUO Lili XUE Yiwei. Risk factors analysis and prediction model construction of nosocomial infection in elderly hospitalized orthopedic patients. 中国医药导报, 2020, 17(3): 86-89,97.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I3/86

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