ICU气管插管病人拔管后吞咽障碍的危险因素分析与预测模型建立

Analysis of risk factors and establishment of prediction model for post-extubation swallowing dysfunction in ICU patients with endotracheal intubation

[目的]通过分析ICU气管插管病人拔管后吞咽障碍的危险因素,建立预测模型。[方法]选取152例外科ICU和综合ICU气管插管拔管后病人,收集病人的一般资料和治疗情况,应用标准吞咽功能评估量表于拔管后4~6 h对病人进行吞咽功能评估。采用单因素分析、二元Logistic回归分析筛选拔管后吞咽障碍的危险因素,根据各危险因素的回归系数构建拔管后吞咽障碍的风险预测模型,并通过Hosmer-Lemeshow(H-L)检验和受试者工作特征(ROC)曲线法对模型进行评价。[结果]152例气管插管病人中,39例(25.7%)出现了拔管后吞咽障碍。二元Logistic回归分析结果显示,年龄、APACHEⅡ评分、留置气管插管时间、留置胃管时间是气管插管病人发生拔管后吞咽障碍的影响因素。预测模型的H-L检验P值为0.099,ROC曲线下面积及95%CI为0.818(0.739,0.898)。取6分为临界值时,模型的灵敏度和特异度较高。[结论]高龄(年龄≥65岁)、APACHEⅡ评分≥15分、留置气管插管时间≥72 h以及留置胃管时间≥72 h的病人拔除气管插管后发生吞咽障碍的风险较高,建议使用预测模型进行风险评估与预测,对于得分≥6分的高危病人应尽早给予干预措施,减少相关并发症的发生。

Objective:To analyze the risk factors for post-extubation swallowing dysfunction in ICU patients with endotracheal intubation,and to establish a prediction model.Methods:A total of 152 post-extubation patients,who underwent endotracheal intubation in the SICU or general ICU,were selected.The general data and treatment status were collected.Swallowing function of patients was assessed by using Standardized Swallowing Assessment Scale at 4~6 hours afer extubation.The risk factors of post-extubation swallowing dysfunction were screened by univariate analysis and binary logistic regression analysis.According to the regression coefficients of each risk factor,the risk prediction model was constructed.Hosmer-Lemeshow(H-L)chi-square test and the receiver operating characteristic(ROC)curve were used to evaluate the model.Results:Among the 152 patients with endotracheal intubation,there were 39 cases suffering from post-extubation swallowing dysfunction,which accounted for 25.7%.Binary logistic regression analysis showed that age,APACHEⅡscore,duration of indwelling endotracheal tube,and duration of indwelling gastric tube were influencing factors for post-extubation swallowing dysfunction of patients with endotracheal intubation.The P value of Hosmer-Lemeshow(H-L)test for the prediction model was 0.099.The area under curve was 0.818.And 95%CI ranged from 0.739 to 0.898.When the cutoff point was 6,the sensitivity and specificity of prediction model were both higher.Conclusions:There was a higher risk for occurence of post-extubation swallowing dysfunction among ICU patients with age≥65 years,APACHEⅡscore≥15,tracheal intubation time≥72 h,and indwelling gastric tube time≥72 h.It was suggested that assesment and prediction of risk should be performed by using the prediction model.And medical staff should give intervention measures for high-risk patients with score≥6 as soon as possible,thus to reduce their complications related to post-extubation swallowing dysfunction.