无创通气患者鼻饲过程中喂养不耐受现状及影响因素分析

Analysis of feeding intolerance and influencing factors in non-invasive mechanical ventilation patients during nasal feeding

目的 探讨无创通气患者鼻饲过程中喂养不耐受现状及影响因素。方法 回顾性分析南通大学附属海安医院2020年6月-2022年6月在重症监护室(ICU)行无创机械通气治疗的156例患者,纳为建模组(喂养不耐受组56例,非喂养不耐受组100例),另将2022年6月-2023年6月医院收治的102例重症患者作为验证组(喂养不耐受组34例,非喂养不耐受组68例)。从医疗系统中收集患者一般人口学资料、临床相关资料及实验室资料,采用Logistic分析无创机械通气患者鼻饲过程中喂养不耐受的影响因素,根据Logistic回归系数建立风险预测模型,通过绘制受试者工作特征(ROC)曲线检验风险预测模型的区分度和校准度,并在验证组中检验该模型的价值。结果 在建模组中,喂养不耐受组与非喂养不耐受组在使用益生菌、空腹血糖、白蛋白、C-反应蛋白、胃泌素方面比较有统计学差异(P均<0.05)。经Logistic回归分析显示,空腹血糖(OR=4.841,95%CI:2.149~10.903)、胃泌素(OR=1.077,95%CI:1.021~1.135)是无创机械通气患者鼻饲过程中喂养不耐受的危险因素,使用益生菌(OR=0.095,95%CI:0.010~0.911)、白蛋白(OR为0.488,95%CI:0.337~0.707)是其保护因素(P<0.05);而C-反应蛋白对喂养不耐受的发生无影响(P>0.05)。构建风险预测模型,绘制ROC曲线对模型进行内部验证,结果显示该模型预测无创机械通气患者鼻饲过程中喂养不耐受发生的曲线下面积(AUC)为0.986,95%CI为0.943~0.989,P<0.001;在验证组中检验风险预测模型价值,结果显示,该模型预测无创机械通气患者鼻饲过程中喂养不耐受发生的AUC为0.944,95%CI为0.912~0.975,P<0.001。结论 无创机械通气患者鼻饲过程中喂养不耐受发生的影响因素有使用益生菌、空腹血糖、白蛋白与胃泌素,基于这四个因素构建的风险预测模型对无创机械通气患者鼻饲过程中喂养不耐受的预测价值良好。

Objective To explore the current status and influencing factors of feeding intolerance in non-invasive mechanical ventilation patients during nasal feeding.Methods The clinical data of 156 patients were retrospectively analyzed,who underwent non-invasive mechanical ventilation treatment in the intensive care unit(ICU)of Haian Hospital affiliated with Nantong University from June 2020 to June 2022.There were 56 cases in the feeding intolerance group and 100 cases in the non feeding intolerance group.In addition,102 critically ill patients admitted to the hospital from June 2022 to June 2023 were selected as the validation group(34 cases in the feeding intolerance group and 68 cases in the non feeding intolerance group).Their general demographic data,clinical data and laboratory data were collected from the medical system.The influencing factors of feeding intolerance in patients with non-invasive mechanical ventilation during nasal feeding were analyzed by Logistic analysis,and a risk prediction model was established according to Logistic regression coefficient.The differentiation and calibration of the risk prediction model were tested by drawing receiver operating characteristic(ROC)curves,and the value of the model was tested in the validation group.Results In the modeling group,there were significant differences in the use of probiotics,fasting blood glucose,albumin,C-reactive protein,and gastrin between the feeding intolerance group and the non feeding intolerance group(P<0.05).According to Logistic regression analysis,fasting blood glucose(OR=4.841,95%CI:2.149~10.903),and gastrin(OR=1.077,95%CI:1.021~1.135)were all risk factors for feeding intolerance during nasal feeding in non-invasive mechanical ventilation patients.The use of probiotics(OR=0.095,95%CI:0.010~0.911)and white protein(OR=0.488,95%CI:0.337~0.707)were protective factors(P<0.05),while C-reactive protein had no effect on the occurrence of feeding intolerance(P>0.05).The risk prediction model was constructed,and the ROC curve was drawn to verify the model internally.The results showed that the area under the curve(AUC)of the model for predicting the occurrence of feeding intolerance during nasal feeding in patients with non-invasive mechanical ventilation was 0.966,and the 95%CI was 0.943~0.989,P<0.001.In the validation group,the value of the risk prediction model was tested,and the results showed that the AUC of feeding intolerance in non-invasive mechanical ventilation patients during nasal feeding was 0.944,with a 95%CI of 0.912~0.975,and P<0.001.Conclusion The influencing factors of feeding intolerance during nasal feeding in non-invasive mechanical ventilation patients include the use of probiotics,fasting blood glucose,albumin,and gastrin.The risk prediction model based on these four factors has good predictive value for feeding intolerance during nasal feeding in non-invasive mechanical ventilation patients.