脑室外引流术后患者颅内感染预测模型的构建及验证

杨雪; 陈图南; 陈志; 张超; 张学应; 魏利; 刘苗; 鲜继淑

doi:10.16016/j.2097-0927.202207086

您当前的位置：

首页 >

文章列表页 >

脑室外引流术后患者颅内感染预测模型的构建及验证

临床医学 | 更新时间：2026-01-09

- 脑室外引流术后患者颅内感染预测模型的构建及验证
- Construction and validation of prediction model of intracranial infection after external ventricular drainage
- 陆军军医大学学报 2023年45卷第3期页码：265-271
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院神经外科
- 作者简介：
  
  [ 鲜继淑，E-mail: 13883789997@163.com XIAN Jishu, E-mail: 13883789997@163.com
- 基金信息：
- DOI：10.16016/j.2097-0927.202207086
  中图分类号： R473.6;R619.3;R651.11
- 收稿：2022-07-12，
  
  修回：2022-08-01，
  
  纸质出版：2023-02-15
- 稿件说明：
移动端阅览
杨雪, 陈图南, 陈志, 等. 脑室外引流术后患者颅内感染预测模型的构建及验证[J]. 陆军军医大学学报, 2023,45(3):265-271.

Xue YANG, Tunan CHEN, Zhi CHEN, et al. Construction and validation of prediction model of intracranial infection after external ventricular drainage[J]. Journal of Army Medical University, 2023, 45(3): 265-271.
杨雪, 陈图南, 陈志, 等. 脑室外引流术后患者颅内感染预测模型的构建及验证[J]. 陆军军医大学学报, 2023,45(3):265-271. DOI： 10.16016/j.2097-0927.202207086.

Xue YANG, Tunan CHEN, Zhi CHEN, et al. Construction and validation of prediction model of intracranial infection after external ventricular drainage[J]. Journal of Army Medical University, 2023, 45(3): 265-271. DOI： 10.16016/j.2097-0927.202207086.

摘要

目的

探讨脑室外引流术后患者颅内感染的影响因素，构建并验证风险预测模型。

方法

采用回顾性资料分析法，选取2010-2018年在本院神经外科行脑室外引流(external ventricular drainage，EVD)手术治疗的患者757例(建模组)，根据术后是否发生颅内感染分为颅内感染组(

=79)和非颅内感染组(

=678)，对两组资料进行对比，利用单因素分析和Logistic回归分析探讨脑室外引流术后患者颅内感染的影响因素，建立风险预测模型并绘制列线图。另选择2019-2020年本院148例EVD患者作为验证组，其中术后颅内感染组8例，非颅内感染组140例；利用ROC曲线下面积和Hosmer-Lemeshow检验来评估模型预测效果。

结果

低蛋白血症、合并腰池引流、脑室外引流时间＞7 d、合并肺部感染、合并气管切开、开放性颅脑外伤、合并手术切口感染、合并菌血症/脓毒血症是脑室外引流术后患者颅内感染的影响因素。预测模型验证结果显示，建模组术后发生颅内感染风险的ROC曲线下面积为0.923(

0.01)，验证组术后发生颅内感染风险的ROC曲线下面积为0.920(

0.01)。建模组和验证组Hosmer-Lemeshow检验的

值分别为0.450和0.877。

结论

脑室外引流术后导致颅内感染的高危影响因素有8项，构建的模型可以有效预测脑室外引流术后患者颅内感染的发生。

Abstract

Objective

To explore the influencing factors of intracranial infection in patients after ventricular drainage

and to build and verify the established risk prediction model.

Methods

A retrospective analysis was carried out on 757 patients who underwent external ventricular drainage (EVD) in our department from January 2010 to December 2018. According to the occurrence of postoperative intracranial infection

they were divided into intracranial infection group (

=79) and non-intracranial infection group (

=678). Their clinical data were collected and compared. Univariate analysis and multivariate logistic regression analysis were used to explore the influencing factors of intracranial infection after ventricular drainage. A risk prediction model was established and anomogram was drawn. Another 148 patients with EVD in our hospital from 2019 to 2020 were selected as the validation group

including 8 patients with intracranial infection after surgery and 140 patients without. The area

under receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test were employed to evaluate the prediction efficacy of the model.

Results

Hypoproteinemia

lumbar cisternae drainage

EVD time

7 d

pulmonary infection

tracheotomy

open craniocerebral trauma

surgical incision infection

and complicated with bacteremia/sepsis were influencing factors of intracranial infection after EVD. The validation results for the prediction model showed that the area under ROC curve for the risk of postoperative intracranial infection was 0.923 in the modeling group and 0.920 in the verification sample (

0.01). As to the Hosmer-Lemeshow test

the

value was 0.450 in the modeling patients and 0.877 in those from the verification group.

Conclusion

There are 8 high-risk factors for incidence of intracranial infection in patients after EVD. Our established model can effectively predict the occurrence of intracranial infection in these patients.

关键词

Keywords

references

CHEN S, FENG H, SHERCHAN P, et al . Controversies and evolving new mechanisms in subarachnoid hemorrhage[J ] . Prog Neurobiol, 2014, 115: 64-91. DOI: 10.1016/j.pneurobio.2013.09.002.

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.

Ministry of Health, PRC. Diagnostic criteria for nosocomial infections(proposed)[J]. Natl Med J China, 2001, 81(5): 314-320.

郝京京, 武元星, 王强. 神经外科术后中枢神经系统细菌性感染诊断的研究进展[J]. 中华神经外科杂志, 2015, 31(10): 1077-1080. DOI: 10.3760/cma.j.issn.1001-2346.2015.10.030.

HAO J J, WU Y X, WANG Q. Research progress in the diagnosis of post-operative central nervous system infection[J]. Chin J Neurosurg, 2015, 31(10): 1077-1080. DOI: 10.3760/cma.j.issn.1001-2346.2015.10.030.

李乐园, 陈翠萍, 陈光远, 等. 脑室外引流管相关感染危险因素的研究进展[J]. 中华现代护理杂志, 2017, 23(24): 3189-3192. DOI: 10.3760/cma.j.issn.1674-2907.2017.24.031.

LI L Y, CHEN C P, CHEN G Y, et al . Recent study progress of risk factors of external ventricular drainage catheter related infections[J ] . Chin J Modern Nursing, 2017, 23(24): 3189-3192. DOI: 10.3760/cma.j.issn.1674-2907.2017.24.031.

中华医学会神经外科学分会, 中国神经外科重症管理协作组. 神经外科脑脊液外引流中国专家共识(2018版)[J]. 中华医学杂志, 2018, 98(21): 1646-1649. DOI: 10.3760/cma.j.issn.0376-2491.2018.21.005.

Branch of Neurosurgery of Chinese Medical Association, Collaboration Group for Chinese Neurosurgical Critical Management. Cerebrospinal fluid outflow in neurosurgery: Chinese expert consensus (2018 edition)[J]. Nat Med J China, 2018, 98(21): 1646-1649. DOI: 10.3760/cma.j.issn.0376-2491.2018.21.005.

张伟宁, 田敏, 张阿宁. 老年重症颅脑外伤术后出现颅内感染的危险因素分析及干预措施[J]. 临床医学研究与实践, 2017, 2(14): 3-5. DOI: 10.19347/j.cnki.2096-1413.201714002.

ZHANG W N, TIAN M, ZHANG A N. Analysis of risk factors and intervention measures of postoperative intracranial infection after senile severe craniocerebral trauma[J]. Clin Res Pract, 2017, 2(14): 3-5. DOI: 10.19347/j.cnki.2096-1413.201714002.

WEIMANN A, BRAGA M, CARLI F, et al . ESPEN guideline: clinical nutrition in surgery[J ] . Clin Nutr, 2017, 36(3): 623-650. DOI: 10.1016/j. clnu.2017.02.013.

HUSSEIN K, RABINO G, FEDER O, et al . Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study[J ] . Acta Neurochir (Wien), 2019, 161(3): 517-524. DOI: 10.1007/s00701-019-03801-y.

CHAMPEY J, MOUREY C, FRANCONY G, et al . Strategies to reduce external ventricular drain-related infections: a multicenter retrospective study[J ] . J Neurosurg, 2018. DOI: 10.3171/2018.1.JNS172486.

SCHEITHAUER S, BVRGEL U, BICKENBACH J, et al . External ventricular and lumbar drainage-associated meningoventriculitis: prospective analysis of time-dependent infection rates and risk factor analysis[J ] . Infection, 2010, 38(3): 205-209. DOI: 10.1007/s15010-010-0006-3.

王李刚. 脑室外引流术后并发颅内感染影响因素分析[J]. 临床心身疾病杂志, 2014(4): 103-105. DOI: 10.3969/j.issn.1672-187X.2014.04.038-0103-03.

WANG L G. Influencing factors of intracranial infection after external ven-tricular drainage[J]. J Clin Psychosomatic Dis, 2014(4): 103-105. DOI: 10.3969/j.issn.1672-187X.2014.04.038-0103-03.

JAMJOOM A A B, JOANNIDES A J, POON M T, et al . Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland[J ] . J Neurol Neurosurg Psychiatry, 2018, 89(2): 120-126. DOI: 10.1136/jnnp-2017-316415.

ROBERTSON F C, ABD-EL-BARR M M, MUKUNDAN S Jr, et al . Ventriculostomy-associated hemorrhage: a risk assessment by radiographic simulation[J ] . J Neurosurg, 2017, 127(3): 532-536. DOI: 10.3171/2016.8.JNS16538.

MOSTOFI K, SAMⅡ M. Secondary communicating hydrocephalus management by implantation of external ventricular shunt and minimal gradual increase of cerebrospinal fluid pressure[J]. Asian J Neurosurg, 2017, 12(2): 194-198. DOI: 10.4103/ajns.AJNS_320_16.

杨欣刚, 安海龙, 马修尧, 等. 重型颅脑损伤患者气管切开术后肺部感染特点与危险因素分析[J]. 中华医院感染学杂志, 2016, 26(2): 323-325. DOI: 10.11816/cn.ni.2016-151972.

YANG X G, AN H L, MA X Y, et al . Characteristics of postoperative pulmonary infections in severe brain injury patients undergoing tracheotomy and analysis of risk factors[J ] . Chin J Nosocomiol, 2016, 26(2): 323-325. DOI: 10.11816/cn.ni.2016-151972.

刘登贤, 顾强, 孙伟, 等. 早期气管切开术对颅脑外伤合并吸入性肺炎患者的疗效评价[J]. 中外医学研究, 2017, 15(22): 134-136. DOI: 10.14033/j.cnki.cfmr.2017.22.071.

LIU D X, GU Q, SUN W, et al . Evaluation of curative effect of early tracheotomy in patients with craniocerebral trauma complicated with aspiration pneumonia[J ] . Chin Foreign Med Res, 2017, 15(22): 134-136. DOI: 10.14033/j.cnki.cfmr.2017.22.071.

戴俊芬, 戴伟民, 戚东静, 等. 颅脑损伤开颅术后肺部感染危险因素分析及预测模型构建[J]. 中华医院感染学杂志, 2021, 31(7): 1034-1038. DOI: 10.11816/cn.ni.2021-201932.

DAI J F, DAI W M, QI D J, et al . Risk factors for postoperative pulmonary infection in patients with craniocerebral injury and establishment of prediction model[J ] . Chin J Nosocomiol, 2021, 31(7): 1034-1038. DOI: 10.11816/cn.ni.2021-201932.

程玮涛, 徐跃峤. 神经外科肺部感染者的细菌学分析[J]. 中华实验和临床感染病杂志(电子版), 2015, 9(2): 226-228. DOI: 10.3877/cma.j.issn.1674-1358.2015.02.017.

CHENG W T, XU Y Q. Bacteriological analysis of neurosurgical patients with pulmonary infection[J]. Chin J Exp Clin Infect Dis Electron Ed, 2015, 9(2): 226-228. DOI: 10.3877/cma.j.issn.1674-1358.2015.02.017.

王雷平, 吴崇光, 姚军, 等. 颅脑创伤患者脑室外引流术后继发颅内感染危险因素分析[J]. 浙江创伤外科, 2019, 24(2): 319-321. DOI: 10.3969/j.issn.1009-7147.2019.02.052.

WANG L P, WU C G, YAO J, et al . Secondary intracranial infection and its factors in patients with traumatic brain injury after external ventricular drainage[J ] . Zh ejiang J Trauma Surg, 2019, 24(2): 319-321. DOI: 10.3969/j.issn.1009-7147.2019.02.052.

BAVISKAR A S, KHATIB K I, RAJPAL D, et al . Nosocomial infections in surgical intensive care unit: a retrospective single-center study[J ] . Int J Crit Illn Inj Sci, 2019, 9(1): 16-20. DOI:10.4103/ijciis.ijciis_57_18.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

老年髋部骨折患者术后1年内死亡的影响因素分析及列线图预测模型构建

孔源性视网膜脱离合并睫状体脱离的发生率及其影响因素研究

458名进藏新兵心理健康状况与影响因素分析

重庆地区健康老年人群社会支持状况及其相关因素分析

西部2个贫困县肺结核患者发现延误情况及其影响因素分析