NICU新生儿留置胃管非计划性拔管风险预测模型的构建及验证

Construction of the predictive model for the risk of unplanned extubation of indwelling gastric tubes in NICU neonates and its vertification

目的构建新生儿重症监护室(neonatal intensive care unit,NICU)新生儿留置胃管非计划性拔管(unplanned extubation,UEX)风险预测模型并进行验证。方法选取潍坊市某三级甲等医院NICU于2020年6月-2023年6月留置胃管的新生儿431例,按7∶3的比例分为建模组300例和验证组131例,使用建模组数据进行单因素及多因素logistic回归分析,筛选新生儿留置胃管UEX的独立危险因素并构建风险预测模型,用验证组数据对模型进行验证。结果最终得到体重≤1500 g、胃管留置方式、留置胃管后是否再固定、管路数量4个独立危险因素,预测模型公式为P=1/(1+e Y),Y=1.752×体重+0.934×胃管留置方式+1.125×胃管留置后是否再固定+1.913×管路数量-5.868。Hosmer-Lemeshow拟合优度检验显示:P值为0.761;建模组和验证组受试者工作特征(ROC)曲线下面积分别为0.943和0.939。结论以体重≤1500 g、经鼻留置胃管、留置胃管后没有再固定、管路数量增多等NICU新生儿留置胃管发生UEX的独立危险因素构建的风险预测模型预测性能良好。

Objective To construct and verify the predictive model for the risk of unplanned extubation(UEX)of indwelling gastric tubes in neonates in neonatal intensive care unit(NICU).Methods A total of 431 neonates with indwelling gastric tubes in the NICU of a tertiary grade-A hospital in Weifang were enrolled from June 2020 to June 2023,and were divided into 300 cases of the modeling group and 131 cases of the validation group according to the ratio of 7∶3,and the modeling group was used to conduct a univariate and multivariate logistic regression analysis to screen for the independent risk factors of UEX of indwelling gastric tubes in neonates and to construct a risk prediction model,and the model was validated with the data of the validation group.Results The final 4 independent risk factors of weight≤1500 g,method of indwelling gastric tube,whether or not to refix the tube after indwelling gastric tube,and number of tubes were obtained,and the formula of the prediction model was P=1/(1+e Y),and Y=1.752×weight+0.934×method of indwelling gastric tube+1.125×whether or not to refix the tube after indwelling gastric tube+1.913×number of tubes-5.868.The results of Hosmer-Lemeshow goodness-of-fit test showed a P-value of 0.761,and the area under the ROC curve in the modeling and validation groups was 0.943 and 0.939.Conclusion Weight≤1500 g,indwelling gastric tube from nose,not to refix the tube after indwelling gastric tube,and an increase in the number of tubes are independent risk factors for UEX of indwelling gastric tubes in neonates in the NICU,and the risk prediction model constructed accordingly has a good predictive performance.