老年患者长期空肠管饲喂养后胆囊胆汁淤积的发生及风险预测研究

Occurrence and risk prediction of cholestasis in elderly patients after jejunal tube feeding

目的基于单中心临床数据分析老年患者长期空肠管管饲喂养后胆囊胆汁淤积的发生率、发生时间及形成的危险因素,构建老年患者长期空肠管管饲喂养后胆囊胆汁淤积的风险预测模型。方法回顾性收集2019年7月至2022年7月经解放军总医院第二医学中心住院并行空肠营养管置入术后超过2周的65岁以上的84例老年患者的临床资料,依据是否发生胆囊胆汁淤积分为两组,统计患者胆囊胆汁淤积的发生率,并对相关危险因素进行单因素及多因素分析,构建相应的风险预测模型,进一步评估模型的预测性能及临床适用性。结果研究共纳入84例患者,胆囊胆汁淤积38例,发生率为45.2%,中位淤胆发生时间为556.5 d。多因素分析结果显示,尿酸、气管插管术、心衰病史、阿尔茨海默病史、糖尿病史是老年患者长期空肠管管饲喂养后胆囊胆汁淤积发生的独立危险因素,基于上述危险因素建立的COX风险预测模型一致性指数为0.78,校准曲线和决策曲线分析法显示该模型具有良好的预测性能和临床适用性。结论老年患者长期空肠管管饲喂养容易出现胆囊胆汁淤积,尿酸、气管插管术、心衰病史、阿尔茨海默病史、糖尿病史是老年患者长期空肠管管饲喂养后胆囊胆汁淤积发生的独立危险因素,基于上述危险因素构建的风险预测模型对胆囊胆汁淤积的发生具有良好的预测能力。

Objective To analyze the incidence,occurrence time and risk factors of cholestasis in the elderly patients after long-term jejunal feeding,and to construct a risk prediction model for cholestasis in the elderly patients after long-term jejunal feeding.Methods Clinical data of 84 the elderly patients over 65 years of age who were hospitalized in the Second Medical Center of PLA General Hospital from July 2019 to July 2022 and underwent jejunal nutrition tube insertion more than 2 weeks after surgery were retrospectively collected.The patients were divided into two groups according to whether cholestasis occurred.The incidence of cholestasis was analyzed.In addition,univariate and multivariate analysis of related risk factors was carried out to construct the corresponding risk prediction model,and the prediction performance and clinical applicability of the model were further evaluated.Results A total of 84 patients were included in the study,of which 38 patients developed cholestasis,with an incidence rate of 45.2%.The median time of tube feeding was 556.5 days.Multivariate analysis showed that:Uric acid,endotracheal intubation,history of heart failure,history of Alzheimer′s disease and history of diabetes were independent risk factors for cholestasis in the elderly patients after long-term feeding in jejunal tubes.The concordance index of COX risk prediction model established based on the above risk factors was 0.78.The Calibration curve and decision curve analysis showed that the model had good predictive performance and clinical applicability.Conclusion The elderly patients are prone to cholestasis after jejunal tube feeding for a long time.Uric acid,tracheal intubation,history of heart failure,history of Alzheimer′s disease and history of diabetes are independent risk factors for cholestasis after jejunal tube feeding for a long time.