急性胰腺炎患者早期肠内营养喂养不耐受风险预警模型构建与验证

Construction and verification of early enteral nutrition feeding intolerance risk warning mode in patients with acute pancreatitis

目的:分析急性胰腺炎患者早期肠内营养喂养不耐受的影响因素,并构建风险预警模型,验证其效果。方法:收集2019年1月至2021年12月收治的需进行肠内营养喂养的急性胰腺炎患者66例,根据是否早期肠内营养喂养耐受分为耐受组(35例)和不耐受组(31例)。分析急性胰腺炎患者早期肠内营养喂养不耐受的风险因素,并构建风险预警模型、判断模型拟合优度。并于2022年1月至12月纳入32例急性胰腺炎患者作为验证组对模型进行验证。结果:多因素分析显示年龄≥60岁、低蛋白血症、APACHEⅡ评分增加、腹腔内压(IAP)水平增高、肠球菌含量增加是患者不耐受的风险因素,双歧杆菌、添加可溶性纤维是患者不耐受的保护性因素(P<0.05)。Hosmer-Lemeshow检验结果显示χ^(2)=9.308,P=0.231,模型公式Logit P=-43.141+年龄×1.466+低蛋白血症×1.110+APACHEⅡ评分×1.533+IAP水平×0.960-双歧杆菌×2.875+肠球菌×2.123-可溶性纤维×1.877。ROC曲线下面积为0.850,约登指数=0.635,灵敏度=0.806,特异度=0.829。结论:本研究构建的预测模型效果较好,可用于临床评估急性胰腺炎患者早期肠内营养喂养不耐受的风险。

Objective:To analyze the influencing factors of early enteral feeding intolerance in patients with acute pancreatitis,and to build a risk early warning mode to verify its effect.Methods:Sixty-six patients with acute pancreatitis requiring enteral nutrition feeding admitted to the hospital from January 2019 to December 2021 were collected and divided into a tolerance group with 35 cases and an intolerance group with 31 cases according to whether early enteral nutrition feeding was tolerated.The risk factors of early enteral feeding intolerance in patients with acute pancreatitis were analyzed and a risk early warning mode was built to judge the goodness of fit of the mode.From January to December 2022,32 patients with acute pancreatitis were included as the validation group to validate the mode.Results:Multivariate analysis showed that age≥60 years old,hypoproteinemia,increased APACHEⅡscore,IAP level increase,and enterococcal content increase were risk factors for intolerance,while bifidobacteria and soluble fiber were protective factors for intolerance(P<0.05).Hosmer-Lemeshow test results showedχ^(2)=9.308,P=0.231,mode formula Logit P=-43.141+age×1.466+hypoproteinemia×1.110+APACHE II score×1.533+IAP level×0.960-bifidobacterium×2.875+enterococcus×2.123-soluble fiber×1.877.The area under the ROC curve was 0.850,Yoden index=0.635,sensitivity=0.806,and specificity=0.829.Conclusion:The prediction mode built in this study is effective and can be used to evaluate the risk of early enteral feeding intolerance in patients with acute pancreatitis.