危重症患儿喂养不耐受过程评估指标敏感度和特异度研究

Sensitivity and specificity of feeding intolerance process evaluation indexes in critically ill children

目的比较不同的过程评估指标或指标组合诊断危重症患儿喂养不耐受的敏感度及特异度。方法收集196例危重症患儿鼻饲开始前5 d内能量摄入情况及喂养不耐受各项过程评估指标的发生情况。通过比较敏感度及特异度,分析7项评估指标中单项指标或联合指标对喂养不耐受的诊断能力。结果分别以启动肠内营养后的5 d内患儿通过肠内营养能量摄入未达到目标能量的2/3或80%为喂养不耐受的诊断标准,7项评估指标中,胃潴留与呕吐2项指标的ROC曲线下面积>0.7。当以未达到目标能量的2/3作为诊断标准时,使用胃潴留单项指标的敏感度及特异度分别为94.28%、73.91%;当以未达到目标能量的80%作为诊断标准时,胃潴留联合呕吐的敏感度及特异度分别为90.83%、68.70%。结论临床医护人员在诊断危重症患儿喂养不耐受时可优先考虑胃潴留与呕吐2项指标联合或单独使用胃潴留,有助于尽早识别患儿喂养不耐受情况,促进其肠内营养有效实施。

Objective To compare the sensitivity and specificity of different process evaluation indexes or index combinations in the diagnosis of feeding intolerance in critically ill children.Methods The energy intake and feeding intolerance process evaluation indexes of 196 critically ill children were collected within 5 days before the start of nasal feeding.By comparing the sensitivity and specificity,the diagnostic ability of single index or index combinations was analyzed.Results The diagnosis of feeding intolerance was made when the children′s energy intake through enteral nutrition did not reach 2/3(criterion 1)or 80%(criterion 2)of target energy within 5 days after starting enteral nutrition.Among the 7 process evaluation indexes,the area under ROC for gastric retention and vomiting alone was>0.7.Against diagnostic criterion 1(2/3 of the target energy),the sensitivity and specificity of gastric retention stood at 94.28%and 73.91%,respectively;against diagnostic criterion 2(80%of the target energy),the sensitivity and specificity of gastric retention plus vomiting stood at 90.83%and 68.70%respectively.Conclusion In the diagnosis of feeding intolerance in critically ill children,the single index of gastric retention or the combination of gastric retention and vomiting are preferred,which may help early identification of feeding intolerance in the children and boost implement of enteral nutrition therapy.