颅脑创伤患者螺旋型鼻肠管幽门后置管成功的影响因素分析

Analysis of factors influencing the success of retropyloric placement of spiral nasointestinal tube in patients with traumatic brain injury

目的探讨影响颅脑创伤患者螺旋型鼻肠管幽门后置管成功的临床因素。方法回顾性分析2016年12月至2020年10月于中南大学湘雅医院神经外科重症监护病房置入螺旋型鼻肠管的267例颅脑创伤患者的临床资料。所有患者置管后均行X线或CT检查,以鼻肠管尖端通过幽门为置管成功。统计患者的一般资料、格拉斯哥昏迷评分(GCS)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、急性胃肠损伤(AGI)分级、是否行亚低温治疗、实验室指标及所应用药物等临床资料,采用单因素分析和多因素logistic回归分析法探讨置管成功的影响因素,通过绘制受试者工作特征曲线,评估有意义指标预测置管成功的效能并确定截断值。结果螺旋型鼻肠管置管总的成功率为89.5%(239/267)。多因素logistic回归分析表明,APACHEⅡ评分(OR=0.792,95%CI:0.663~0.946,P=0.010)、AGI分级(OR=0.119,95%CI:0.034~0.424,P=0.001)、亚低温治疗(OR=0.225,95%CI:0.051~0.985,P=0.048)和血浆白蛋白水平(OR=1.178,95%CI:1.045~1.328,P=0.007)是颅脑创伤患者螺旋型鼻肠管幽门后置管成功的独立影响因素,其曲线下面积(95%CI)分别为0.800(0.727~0.872)、0.791(0.721~0.861)、0.650(0.525~0.775)、0.799(0.733~0.865)。分别以10分和30.7 g/L为界,应用APACHEⅡ评分(分别为85.7%和61.9%)和血浆白蛋白水平能获得最佳的灵敏度和特异度(分别为89.3%和61.9%)。结论APACHEⅡ评分、AGI分级、亚低温治疗和血浆白蛋白水平可作为预测颅脑创伤患者螺旋型鼻肠管幽门后置管成功的良好指标。

Objective To investigate the influencing factors of successful retropyloric placement of spiral nasointestinal tube in patients with traumatic brain injury(TBI).Methods A retrospective analysis was conducted on the clinical data of 267 patients with TBI at the Intensive Care Unit,Department of Neurosurgery,Xiangya Hospital,Central South University from December 2016 to October 2020.All patients underwent X-ray or CT examination after the tube was inserted,and successful placement was defined as tube tip passing through the pylorus based on imaging results.Information was collected regarding baseline characteristics,Glasgow coma scale(GCS),acute physiology and chronic health evaluation(APACHE)Ⅱscore,acute gastrointestinal injury(AGI)grade,whether the patient underwent hypothermia therapy or not,laboratory parameters and medications,etc.Univariate and multiple logistic regression were performed to identify the contributing factors of successful placement.Receiver operating characteristic(ROC)curves were plotted and the significant indicators were applied to evaluate the efficacy of predicting successful placement.The optimal cut-off values were calculated accordingly.Results The overall success rate of intubation was 89.5%(239/267).APACHEⅡscore(OR=0.792,95%CI:0.663-0.946,P=0.010),AGI grade(OR=0.119,95%CI:0.034-0.424,P=0.001),hypothermia therapy(OR=0.225,95%CI:0.051-0.985,P=0.048)and the level of serum albumin(OR=1.178,95%CI:1.045-1.328,P=0.007)were independent contributing factors of successful tube placement,with AUC of 0.800(0.727-0.872),0.791(0.721-0.861),0.650(0.525-0.775),0799(0.733-0.865)respectively.The optimal cut-off values for APACHEⅡand serum albumin were 10(with the sensitivity of 85.7%and specificity of 61.9%)and 30.7 g/L(with the sensitivity of 89.3%and specificity of 61.9%)respectively.Conclusion APACHEⅡscore,AGI grade,hypothermia therapy and serum albumin are good predicting factors for successful retropyloric nasointestinal placement in patients with TBI.