机械通气老年脓毒症患者并发重症监护病房获得性衰弱的风险因素分析及mNUTRIC评分的早期预测价值

Analysis of risk factors of concurrent ICU acquired weakness in elderly patients with sepsis undergoing me⁃chanical ventilation and the early predictive value of mNUTRIC score

目的分析机械通气老年脓毒症患者并发重症监护病房(ICU)获得性衰弱(ICUAW)的风险因素,并探讨改良版危重症营养风险(mNUTRIC)评分对ICUAW的早期预测价值。方法选取本院ICU收治的320例机械通气老年脓毒症患者作为研究对象,并根据是否发生ICUAW将患者分为ICUAW组(n=98)与非ICUAW组(n=222)。分别收集并比较两组患者入ICU时的一般资料、mNUTRIC评分及实验室指标。比较不同mNUTRIC评分组的ICUAW发生率。采用多因素logistic回归分析、受试者工作特征(ROC)曲线探讨mNUTRIC评分与机械通气老年脓毒症患者并发ICUAW的关系。结果ICUAW组患者年龄、体质量指数、查尔森合并症指数评分、序贯器官衰竭评估评分、急性生理学与慢性健康状况评价系统Ⅱ评分、mNUTRIC评分、脓毒性休克比例、机械通气时间以及血乳酸水平显著高于或长于非ICUAW组,而血清白蛋白水平显著低于非ICUAW组(P<0.05)。不同mNUTRIC评分危险分层ICUAW发生率分别为0~4分(6.28%)、5~9分(66.67%),差异有统计学意义(χ^(2)=132.141,P<0.001)。多因素logistic回归分析结果显示,合并脓毒性休克(OR=2.238,95%CI:1.099~4.555,P=0.026)、长机械通气时间(OR=1.131,95%CI:1.019~1.254,P=0.020)和mNUTRIC评分值升高(OR=2.508,95%CI:1.968~3.196,P<0.001)为机械通气老年脓毒症患者并发ICUAW的独立危险因素。ROC曲线分析结果显示,mNUTRIC评分预测机械通气老年脓毒症患者并发ICUAW的ROC曲线下面积为0.870(95%CI:0.828~0.905),灵敏度为87.76%,特异度为80.63%。结论入ICU时mNUTRIC评分对预测机械通气老年脓毒症患者并发ICUAW与否具有较高的临床价值。

Objective To analyze the risk factors of concurrent intensive care unit acquired weakness(ICUAW)in elderly patients with sepsis undergoing mechanical ventilation(MV),and to explore the early predic⁃tive value of modified Nutrition Risk in the Critically ill(mNUTRIC)score for ICUAW.Methods 320 elderly patients with sepsis undergoing MV admitted to the ICU of our Hospital were enrolled and assigned to the ICUAW group(n=98)and the non⁃ICUAW group(n=222)according to whether ICUAW occurred.The general datas,mNUTRIC score and laboratory index at ICU admission were collected and compared.The incidence of ICUAW in different mNUTRIC score evaluation groups was compared.Multivariate logistic regression analysis and receiver operating characteristic(ROC)curve were used to explore the relationship between mNUTRIC score and concurrent ICUAW in elderly patients with sepsis undergoing MV.Results The age,body mass index,charlson comorbidity Index score,sequential organ failure assessment score,acute physiology and chronic health evaluation systemⅡscore,mNUTRIC score,the proportion of septic shock,the duration of MV and serum lactate level in ICUAW group were significantly higher or longer than those in the non⁃ICUAW group,while the serum albumin level in ICUAW group was significantly lower than that in the non⁃ICUAW group(P<0.05).The percent of patients with ICUAW in different mNUTRIC scores with 0~4 points and 5~9 points were 6.28%,66.67%,respectively,and the difference was statistically significant(χ^(2)=132.141,P<0.001).Multivariate logistic regression analysis showed that concurrent septic shock(OR=2.238,95%CI:1.099~4.555,P=0.026),long duration of MV(OR=1.131,95%CI:1.019~1.254,P=0.020)and elevated value of mNUTRIC score(OR=2.508,95%CI:1.968~3.196,P<0.001)were independent risk factors for concurrent ICUAW in elderly patients with sepsis undergoing MV.The ROC curve analysis showed that the area under the ROC curve,sensitivity and specificity of mNUTRIC score in predicting concurrent ICUAW in elderly patients with sepsis undergoing MV were 0.870(95%CI:0.828~0.905),87.76%and 80.63%,respectively.Conclusion mNUTRIC score at ICU admission has a high clinical value in predicting concurrent ICUAW in elderly patients with sepsis undergoing MV.