目的: 探索老年营养风险指数(GNRI)与ICU患者拔管后不良结局之间的关系。方法: 回顾性分析2020年7月1日至2023年1月31日南京医科大学附属无锡人民医院1 153例符合条件的ICU老年患者临床资料。根据GNRI将营养风险分为4个亚组：高风险组(GNRI＜82)、中风险组(82≤GNRI≤91)、低风险组(92≤GNRI≤98)、无风险组(GNRI＞98)，比较各组拔管后不良结局发生情况。采用多因素Logistic回归分析和限制性立方样条(RCS)分析GNRI与不良结局之间的关系，并采用多元线性回归分析GNRI与ICU住院时间和总住院时间的关系。结果: 与未发生不良结局的老年患者相比，发生不良结局的老年患者GNRI更低(P＜0.001)，随着GNRI下降，ICU住院时间和总住院时间逐渐增加(趋势P＜0.001)。与无风险组比较，高风险组患者拔管后30 d内死亡(OR=2.76,95%CI 1.40～5.46)、肺炎(OR=3.07,95%CI 1.42～6.68)、72 h内再插管(OR=2.41,95%CI 1.06～5.49)和拔管后吞咽困难(OR=2.94,95%CI 1.19～7.31)的发生风险均最高(均趋势P＜0.001)。RCS分析显示GNRI与拔管后不良结局之间存在线性关系(非线性P＞0.05)，GNRI与ICU住院时间和总住院时间呈负相关。结论: ICU老年患者的GNRI值与拔管后不良结局呈负相关，GNRI值越低，拔管后发生不良结局的风险越高，应重视老年患者的营养风险，及时防范。

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