老年烧伤气管切开患者死亡风险诊断模型
构建及对策分析

doi:10.3877/cma.j.issn.2095-655X.2023.04.007

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摘要目的探讨老年烧伤气管切开患者死亡风险诊断模型的构建及应对措施。方法收集2013年1月至2023年1月内蒙古医科大学第三附属医院212例老年烧伤气管切开患者的临床资料，根据入院60d后好转出院或死亡将患者分为存活组 (n=156) 和死亡组（n=56）。对比分析两组患者临床资料及住院期间并发症，将两组患者差异有统计学意义的变量纳入多因素Logistic回归模型，分析死亡独立危险因素，建立模型列线图，并绘制受试者工作特征(ROC)曲线评估模型性能。采用一致性系数评价模型预测性能，采用校准曲线描述模型符合度。结果存活组和死亡组患者年龄［（67.32±5.87)岁，（71.67±7.57)岁］，总住院时间［(49.35±18.76)d，（30.14±8.81)d］及烧伤重症监护室停留时间［(20.83±10.61)d，(26.64±8.81)d］，Ⅲ°烧伤面积［9.50(3.00,15.00)%，12.00(4.00,17.00)%］，总烧伤面积［20.00(15.00,26.00)%,38.00(24.25,55.00)%］，伤前基础疾病［64(41.03%)，44(78.57%)］，呼吸机辅助呼吸［49(31.41%),25(44.64%)］，呼吸机相关肺炎（VAP）发生率［34(21.79%),25(44.64%)］比较，均差异有统计学意义（t=2.76，7.12，2.59；Z=2.84，3.84；χ2=23.24，13.70，10.71；均P＜0.05）。多因素Logistic回归分析示年龄(OR=2.041,95%CI 1.524～2.807)，伤前基础疾病( OR=2.153，95%CI 1.572～3.046)与VAP(OR=3.697，95%CI 1.622～9.035) 为死亡独立危险因素（均P＜0.01）。模型校准曲线一致性系数为0.906，ROC曲线下面积为0.872（95%CI 0.821~0.923）。模型校准曲线表明预测结果与临床预后一致性较高。结论年龄、伤前基础疾病与VAP为老年烧伤气管切开患者死亡独立危险因素，应加强该类患者伤前基础疾病治疗，预防VAP发生。

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关键词 ：烧伤, 气管切开术, 肺炎, 呼吸机相关性, 死亡

Abstract：ObjectiveTo explore the construction of a death risk diagnosis model in elderly burn patients after tracheotomy and analyze the countermeasures. MethodsFrom January 2013 to January 2023, clinical data of 212 senior burn patients at the third Affiliated Hospital of Inner Mongolia Medical University were collected. The patients were divided into 2 groups based on whether they survived (n=156) or died (n=56) after 60 days of hospitalization. The 2 groups′ clinical data and complications during hospitalization were compared and studied. To examine the independent risk factors for mortality, the variables with statistically significant differences between the 2 groups were included in the multivariate Logistic regression model. To test the model's performance, the model nomogram was established and the receiver operating characteristic (ROC) curve was generated. The concordance index was used to evaluate the model′s prediction performance, while the calibration curve was utilized to explain the prediction model′s conformance. ResultsThe age ［(67.32±5.87) years old, (71.67±7.57) years old，t=2.76］, total hospitalization time ［(49.35±18.76) days, (30.14±8.81) days, t=7.12］, the stay time in the burn intensive care unit ［(20.83±10.61) days, (26.64±8.81) days, t=2.59］, Ⅲ ° burn area ［9.50(3.00, 15.00)%, 12.00(4.00, 17.00)%, Z=2.84］, total burn area ［20.00(15.00, 26.00)%, 38.00(24.25, 55.00)%, Z=3.84］, basic disease before injury ［64(41.02%), 44(78.57%)，χ2=23.24］, ventilator-assisted respiration ［49(31.41%), 25(44.64%), χ2=13.70］ and incidence of ventilator-associated pneumonia (VAP) ［34(21.79%), 25(44.64%), χ2=10.71］ showed statistically significant differences between the 2 groups (all P＜0.05). The results of multivariate Logistic regression analysis showed that age (OR=2.041, 95%CI 1.524-2.807), basic disease before injury (OR=2.153, 95%CI 1.572-3.046), and VAP (OR=3.697, 95%CI 1.622-9.035) were independent risk factors for mortality (all P＜0.01).The calibration curve′s concordance index was 0.906, and the area under the ROC curve was 0.872 (95%CI 0.821-0.923). The prediction model's calibration curve demonstrated that the prediction results were congruent with the clinical prognosis. ConclusionAge, pre-existing disease before injury and VAP are independent risk factors for death in elderly burn patients with tracheotomy, the treatment of pre-existing diseases before injury, as well as VAP prevention should be strengthened.

Key words： Burns Tracheotomy Pneumonia, ventilator-associated Death

收稿日期: 2023-04-26

基金资助:内蒙古自治区卫生健康科技计划项目(202201515)

通讯作者: 郭蕊， Email: 280490555@qq.com

引用本文:

王燕1郭蕊2王淑杰1. 老年烧伤气管切开患者死亡风险诊断模型构建及对策分析[J]. 中华诊断学电子杂志, 2023, 11(4): 249-253.
Wang Yan1, Guo Rui2, Wang Shujie1.. Construction of a death risk diagnosis model in elderly burn patients after tracheotomy and analysis of countermeasures. zhzdx, 2023, 11(4): 249-253.

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