腹部创伤患者肠内营养喂养不耐受风险预测模型的构建

Construction of a risk prediction model for enteral nutrition feeding intolerance in patients with abdominal trauma

目的探究腹部创伤患者肠内营养喂养不耐受(FI)的影响因素并构建风险预测模型。方法本研究为回顾性研究。采用病历查询方式收集2021年1月—2023年1月于郑州大学第一附属医院急诊外科收治的腹部创伤且接受肠内营养患者的一般资料和临床资料(急性生理与慢性健康评分、格拉斯哥昏迷评分、创伤严重程度评分、急性胃肠损伤分级情况等);根据患者接受肠内营养3 d内是否发生FI分为FI组和非FI组。采用多因素Logistic回归分析探讨腹部损伤患者FI的影响因素并构建相关风险预测模型;采用受试者工作特征曲线下面积评估预测模型诊断价值。结果共纳入101例研究对象,其中肠内营养FI患者30例,肠内营养非FI患者71例。多因素Logistics回归分析结果显示,创伤严重程度评分、急性胃肠损伤分级、低蛋白血症是腹部损伤患者肠内营养FI的影响因素(P<0.05)。根据上述因素构建腹部损伤患者肠内营养FI风险预测模型,预测模型的受试者工作特征曲线下面积(AUC)为0.856,灵敏度为0.833、特异度为0.732、约登指数为0.565、最佳临界值为0.265。结论构建的腹部损伤患者肠内营养FI风险预测模型有较好的预测效能,可为医护人员预测腹部损伤患者肠内营养FI的发生风险提供参考。

Objective To explore the influencing factors of enteral nutrition feeding intolerance(FI)in patients with abdominal trauma and construct a risk prediction model.Methods This was a retrospective study.General and clinical data such as Acute Physiology and Chronic Health Evaluation(APACHEⅡ),Glasgow Coma Scale(GCS),Injury Severity Score(ISS),and Acute Gastrointestinal Injury(AGI)of patients with abdominal trauma and enteral nutrition admitted to Department of Emergency Surgery of the First Affiliated Hospital of Zhengzhou University from January 2021 to January 2023 were collected by means of medical record inquiry.Patients were divided into FI group and non-FI group according to whether FI occurred within three days after receiving enteral nutrition.Multivariate Logistic regression analysis was used to explore the influencing factors of FI in patients with abdominal injury and to construct the related risk prediction model.The diagnostic value of the prediction model was evaluated by the area under the receiver operating characteristic curve.Results A total of 101 research objects were included,including 30 patients with enteral nutrition FI and 71 patients without enteral nutrition FI.The multivariate Logistic regression results analysis showed that injury severity score,acute gastrointestinal injury grading,and hypoalbuminemia were the influencing factors of enteral nutrition FI in patients with abdominal injury(P<0.05).A risk prediction model for enteral nutrition FI in patients with abdominal injury was constructed based on the above factors.The area under the receiver operating characteristic curve(AUC)of the predictive model was 0.856,with a sensitivity of 0.833,a specificity of 0.732,a Jordan index of 0.565,and an optimal critical value of 0.265.Conclusions The constructed risk prediction model for enteral nutrition FI in patients with abdominal injury has good predictive performance,which can provide a reference for medical staff to predict the risk of enteral nutrition FI in patients with abdominal injury.