| Objective:1.Describe the postoperative ventilator-associated pneumonia in patients with heart valve replacement;2.Analysis of concurrent postoperatively in patients with heart valve replacement or forming risk factors of ventilator associated pneumonia;3.The nomogram model was drawn based on the Logistic regression model,and the results of the regression model were visualized,so as to provide an evaluation tool for the early clinical identification of high-risk patients and the early intervention of high-risk patients.Methods:Using the investigation method of the retrospective case study,according to the inclusion exclusion criteria of this study,patients undergoing mechanical ventilation after heart valve replacement surgery from January2019 to November 2022 were selected in November 2019 as the study subjects.Retrospective analysis of risk factors for ventilator-related pneumonia after heart valve replacement using the questionnaire of ventilator-related pneumonia after heart valve replacement.Data were entered using Epi Data3.1 pairs,and statistical analysis was performed using SPSS21.0.First,univariate analysis of the included independent variables,and second,the variables in univariate analysis(P <0.05)were screened for the influencing factors of VAP after heart valve replacement,and the nomogram was drawn by R4.2.2 software.The nomogram model was also internally verified by the Bootstap self-strap sampling method,using ROC curve and calibration calibration curve to draw the decision curve DCA plot to evaluate the clinical validity of the model.Results:1.This study collected 897 patients with cardiac valve replacement or forming,including 100 patients with postoperative VAP,postoperatively in patients with heart valve replacement or forming the incidence of VAP was11.1%.2.VAP and non-VAP groups in age,preoperative LVEF,previous COPD,underlying diseases,smoking history,surgery time,cardiopulmonary bypass time,serum albumin,ICU treatment duration,white blood cell count abnormalities,PAH,mechanical ventilation support duration,days of indwelling gastric tube,central venous catheterization days,sedative and analgesic use time,antibiotic use duration,and secondary intubation(P<0.05).3.The ICU treatment time[(OR=1.205,95% CI(1.139,1.276)],age[(OR = 1.226,95% CI(1.167,1.289)],operation time [(OR=1.508,95%CI(1.503,1.905)],extracorporeal circulation time [(OR=1.151,95% CI(1.098,1.206)],serum albumin [(OR=0.404,95% CI(0.299,0.546)],Is postoperatively in patients with heart valve replacement or forming predictors of VAP.4.Based on ICU treatment time,age,extracorporeal circulation time,operation time,serum albumin,the five variables to build the Logistic Regression equation: Logit(P)=-23.758+0.187(duration of ICU treatment)+0.204(age)+ 0.411(the time of surgery)+ 0.14(time of cardiopulmonary bypass)-0.907(serum albumin).The model Hosmer-Lemeshow test P =0.803(P > 0.05),the area under the ROC curve AUC = 0.968,95% CI 0.9570.979,about an index = 0.851 = 0.940 sensitivity,specific degrees = 0.911,accuracy rate = 93.6%,DCA decision analysis curves show that the model of the red line away from the black ash two lines,this study build risk prediction model has good clinical application value and certain clinical benefit.Conclusion:1.ICU treatment time,age,extracorporeal circulation time,operation time,serum albumin is heart valve replacement,or forming the influence factors of postoperative VAP patients,clinical medical staff should give personalized to early identify high-risk patients and preventive measures.2.The risk prediction model of VAP in patients with heart valve replacement patients constructed in this study has good prediction effect,which can provide scientific basis for medical staff of cardiothoracic surgery to identify the risk of postoperative VAP in patients with heart valve replacement,and take measures to prevent VAP as soon as possible to reduce the risk of VAP in postoperative patients. |
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