ICU气管插管患者口腔黏膜压力性损伤风险列线图模型的构建

Construction of risk nomogram model of oral mucosal pressure injury in patients with tracheal intubation in ICU

目的探讨ICU气管插管患者口腔黏膜压力性损伤(OMPI)的危险因素,并构建列线图模型。方法采用便利抽样法,选取2023年1—5月新疆医科大学第一附属医院ICU收治的640例经口气管插管患者为研究对象,按照是否发生OMPI分为发生组(n=286)和未发生组(n=354)。采用二项Logistic回归分析探讨ICU气管插管患者发生OMPI的危险因素,基于独立危险因素创建风险列线图模型,并通过Bootstrap重复抽样法进行内部验证。结果640例ICU气管插管患者中286例患者发生了OMPI。二项Logistic回归分析结果显示,APACHEⅡ高、改良Beck口腔评分≥11分、使用镇静药物、俯卧位通气、气管导管留置时间长、氧合指数<200 mmHg(1 mmHg=0.133 kPa)、气管导管固定频次为1次/24 h是ICU气管插管患者发生OMPI的危险因素(P<0.05)。基于独立危险因素建立ICU气管插管患者OMPI风险列线图模型,结果显示,ICU气管插管患者OMPI风险列线图模型预测性能(受试者工作特征曲线下面积为0.918,95%置信区间:0.897~0.938)和校准度(χ^(2)值为4.647,P=0.795)良好;当阈值概率处于0~1时,决策曲线显示该模型临床效用较好。结论本研究构建的ICU气管插管患者OMPI风险列线图模型具有良好的校准度和预测性能,可作为筛查高风险患者的有效工具。

Objective To explore the risk factors of oral-mucosal pressure injury(OMPI)in patients with tracheal intubation in ICU and to establish a nomogram model.Methods Using the convenient sampling method,a total of 640 patients with oral tracheal intubation admitted to ICU of the First Affiliated Hospital of Xinjiang Medical University from January to May 2023 were selected as the research objects.They were divided into the occurrence group(n=286)and the non-occurrence group(n=354)according to whether OMPI occurred or not.Binomial Logistic regression analysis was used to explore the risk factors for OMPI in patients with tracheal intubation in ICU.A risk nomogram model was created based on independent risk factors,and internal verification was conducted by Bootstrap repeated sampling method.Results OMPI occurred in 286 of 640 ICU patients with tracheal intubation.Binomial Logistic regression analysis showed that high APACHEⅡscore,modified Beck oral score greater than or equal to 11 points,use of sedative drugs,prone ventilation,long retention time of tracheal catheter,low oxygenation index less than 200 mmHg(1 mmHg=0.133 kPa)and tracheal catheter fixation frequency of 1 time/24 h were the risk factors for OMPI in patients with tracheal intubation in ICU(P<0.05).A risk nomogram model for OMPI in patients with tracheal intubation in ICU was established based on independent risk factors.The results showed that the predictive performance(area under the receiver operating characteristic curve of subjects was 0.918,95%confidence interval was 0.897 to 0.938)and calibration(χ^(2) value of 4.647,P=0.795)of the risk nomogram model for OMPI in patients with tracheal intubation in ICU were good.When the threshold probability was 0 to 1,the decision curve showed that the model had good clinical effectiveness.Conclusions The OMPI risk nomogram model of tracheal intubation patients in ICU established in this study has good calibration and differentiation,which can be used as an effective tool for screening high-risk patients.