基于陕南多中心数据的重度胡蜂蛰伤患者早期肠内营养过程喂养不耐受的研究

Feeding intolerance during early enteral nutrition in patients with severe wasp stings based on multicenter data from southern Shanxi

目的探讨从重度胡蜂螫伤患者临床早期指标中,筛选早期肠内营养(EEN)过程发生喂养不耐受(FI)的危险因素,进而构建早期预测评估工具。方法回顾性分析2020年5月—2023年5月在西安交通大学医学部附属三二〇一医院重症医学科(ICU)及陕南三所重症胡蜂蛰伤定点救治机构住院时间超过96 h且符合纳入标准的119例重度胡蜂螫伤患者临床资料,根据EEN过程中是否发生FI分为喂养耐受组87例和喂养不耐受组32例。以EEN过程中发生FI作为预后观察指标,评价临床早期易获取的各项指标及常用评分系统是否为患者EEN过程中FI的危险因素。应用单因素Logistic回归分析及多因素Logistic回归模型中的双向逐步回归策略选择预测FI发生的独立危险因素。根据预测因素得出回归方程,应用R语言软件绘制可视化列线图,采用ROC曲线检测该线列图的效能。结果单因素Logistic回归分析显示,影响因素有蜇伤数目、腹内压、急性生理与慢性健康评分(APACHEⅡ)、乳酸、降钙素原、C反应蛋白(CRP)(P<0.05)。继续行多因素双向逐步Logistic回归分析显示,蛰伤数目(OR=1.177,95%CI:1.082~1.281,P<0.001)、CRP(OR=1.080,95%CI:1.023~1.130,P=0.001)是重度胡蜂螫伤患者EEN过程中FI的独立危险因素。ROC曲线分析结果显示,该列线图对重度胡蜂螫伤患者EEN过程中发生FI具有优秀的预测能力(AUC=0.984,95%CI:0.965~1.000)。结论蛰伤数目和CRP是重度胡蜂螫伤患者EEN过程FI的独立危险因素,以这些参数所绘列线图能够早期、有效、便捷地预测FI的发生风险,临床上具有较高的推广价值。

Objective This study aimed to screen the risk factors of feeding intolerance during early enteral nutrition from the early clinically common test indexes of Severe Wasp Sting patients,and then construct an early predictive scoring model.Methods The clinical data from 119 severe wasp sting patients who were admitted at Intensive Care Unit(ICU)of 3201 Hospital of Xian Jiaotong University Health Science Center,and three designated treatment institutions for severe wasp stings in southern Shanxi,for over 96h from May 2020 to May 2023 and conformed to the inclusion criteria were retrospectively analyzed.The incidence of feeding intolerance was used as the prognosis observational index to evaluate whether the early clinically common test indexes and scoring systems were the independent risk factors for severe wasp sting complicated with feeding intolerance during early enteral nutrition.The univariate regression analysis and two-way stepwise strategy in the multivariate logistics regression model were used to select the risk factors for predicting the occurrence of feeding intolerance.According to the predicted factors,the regression equation was obtained.A visual nomogram was established using R language sofeware,and the efficacy of the nomogram was assessed by a Receiver Operating Characteristic(ROC)curve.Results The univariate regression analysis results indicated that,the influencing factors were number of stings,intra-abdominal pressure,Acute Physiology and Chronic Health Evaluation,lactate,procalcitonin and C-reactive protein(P<0.05).Further two-way stepwise strategy in the multivariate logistics regression analysis indicated that,number of stings(OR=1.630,95%CI:1.018~1.175,P=0.006),the C-reactive protein(OR=1.107,95%CI:1.023~1.199,P=0.012)were the independent risk factors for severe wasp sting complicated with Feeding Intolerance During Early Enteral Nutrition.ROC curve analysis results showed that This nomogram has excellent predictive power for severe wasp sting complicated with feeding intolerance during early enteral nutrition(AUC=0.984,95%CI:0.965~1.000).Conclusion Number of stings,C-reactive protein are the main risk factors for severe wasp sting complicated with feeding intolerance during early enteral nutrition.The nomogram we constructed with these parameters can predict the risk of Feeding Intolerance early,effectively and conveniently,and have high value in clinical practical promotion and application.