老年危重症患者发生再喂养综合征的危险因素回归方程的构建及干预措施分析

Establishment of a regression equation for risk factors of refeeding syndrome in critically ill elderly patients and analysis of intervention measures

目的构建老年危重症患者发生再喂养综合征(RFS)的危险因素回归方程,并分析相应的干预措施。方法回顾性分析2021年1月—2023年3月重症监护室(ICU)收治的154例老年危重症患者的临床资料,根据RFS发生情况分为RFS组51例和非RFS组103例。采用Logistic回归模型分析影响发生RFS的因素;采用受试者工作特征(ROC)曲线分析预测因子对RFS的预测价值;构建并验证相关Logistic回归方程,拟定相关护理干预内容。结果老年危重症患者发生RFS与急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、营养风险筛查2002(NRS2002)评分、有创机械通气、喂养前禁食时间、D-二聚体水平、营养摄入方式和喂养前血磷、血钾、血镁水平有相关性(P<0.05)。Logistic回归分析显示,APACHEⅡ评分、NRS2002评分、营养摄入方式和喂养前血磷、血钾水平均为影响老年危重症患者发生RFS的独立危险因素(P<0.05)。ROC曲线结果显示,APACHEⅡ评分、NRS2002评分、营养摄入方式和喂养前血磷、血钾水平和联合预测因子预测老年危重症患者发生RFS的曲线下面积(AUC)分别为0.754、0.723、0.707、0.783、0.774和0.859(P<0.05)。发生RFS的Logistic回归方程为L=0.085×APACHEⅡ评分-0.337×NRS 2002评分+0.537×营养摄入方式-0.776×喂养前血磷水平-0.207×喂养前血钾水平+0.942。该方程预测价值良好,可根据方程拟定针对性的护理干预措施。结论危险因素回归方程可用于老年危重症患者RFS发生风险的临床预测,临床可根据回归方程制订相关护理干预措施,预防RFS的发生。

Objective To establish a regression equation for risk factors of refeeding syndrome(RFS)in critically ill elderly patients and analyze the relevant intervention measures.Methods Clinical materials of 154 critically ill elderly patients treated in Intensive Care Unit(ICU)from January 2021 to March 2023 were retrospectively analyzed,and they were divided into RFS group(n=51)and non-RFS group(n=103)according to incidence condition of RFS.The influencing factors of RFS were analyzed by Logistic regression model;the predictive values of predictors for RFS were analyzed by receiver operating characteristic(ROC)curve;the relevant Logistic regression equations were constructed and verified,and relevant nursing interventions were formulated.Results The incidence of RFS in critically ill elderly patients was correlated with the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ)score,the Nutritional Risk Screening 2002(NRS2002)score,invasive mechanical ventilation,fasting time before feeding,D-dimer level,nutritional intake methods,and pre-feeding blood phosphorus,potassium and magnesium levels(P<0.05).Logistic regression analysis showed that APACHEⅡ score,NRS2002 score,nutrient intake methods and pre-feeding blood phosphorus and potassium levels were the independent risk factors of RFS in critically ill elderly patients(P<0.05).The ROC curve results showed that the values of area under the curve(AUC)of APACHEⅡ score,NRS2002 score,nutritional intake methods,pre-feeding blood phosphorus and potassium levels,and the combined predictor in predicting the incidence of RFS in critically ill elderly patients were 0.754,0.723,0.707,0.783,0.774 and 0.859,respectively(P<0.05).The Logistic regression equation for RFS was as follow:L=0.085×APACHEⅡ score -0.337×NRS 2002 score +0.537×nutrient intake methods -0.776×pre-feeding blood phosphorus level -0.207×pre-feeding blood potassium level +0.942.The predictive value of this equation was good,and targeted nursing interventions could be formulated based on this equation.Conclusion The regression equation of risk factors can be used for clinical prediction of the RFS risk in critically ill elderly patients,and clinical nursing interventions can be formulated based on the regression equation to prevent the occurrence of RFS.