脑出血患者早期肠内营养并发误吸的危险因素分析及预测模型构建-现代医学

脑出血患者早期肠内营养并发误吸的危险因素分析及预测模型构建

单位：首都医科大学附属北京康复医院中医康复中心, 北京 100144

分类号：R743.34

出版年·卷·期（页码）：2025·53·第五期（804-809）

摘要：

目的： 分析脑出血患者早期肠内营养(EN)并发误吸的危险因素及构建其预测模型。方法： 回顾性选取2021年1月—2024年2月我院收治的行早期EN支持的158例脑出血患者，依据是否发生误吸分为误吸组(61例)与非误吸组(97例)。收集脑出血患者临床资料，Logistic回归分析脑出血早期EN患者并发误吸的影响因素，构建预测模型，绘制受试者工作特征(ROC)曲线评价误吸预测模型的预测效能，Hosmer-Lemeshow检验与校准曲线评价模型校准度。结果： 误吸组高营养风险比例、昏迷比例、EN支持形式持续式比例、鼻饲管管径3.5 mm比例、鼻饲管置入长度、白细胞计数(WBC)水平均高于非误吸组，床头抬高30°～45°比例低于非误吸组(P＜0.05)。Logistic回归分析显示营养风险(OR=8.358，95%CI 1.179～59.245)、意识状态(OR=7.557，95%CI 1.241～46.012)、床头抬高情况(OR=0.102，95%CI 0.012～0.873)、鼻饲管置入长度(OR=1.085，95%CI 1.016～1.159)、鼻饲管管径(OR=8.150，95%CI 1.217～54.582)、WBC计数(OR=2.741，95%CI 1.641～4.577)是脑出血早期EN患者并发误吸的影响因素(P＜0.05)。由影响因素构建的回归预测模型，通过ROC曲线评价该误吸模型的预测效能显示，曲线下面积(AUC)为0.949，灵敏度为0.918，特异度为0.825。Hosmer-Lemeshow检验显示χ²=12.175，P=0.144，且校准曲线显示校正曲线与理想曲线较接近，绝对平均误差为0.014。结论： 高营养风险、昏迷、鼻饲管管径3.5 mm、鼻饲管置入长度越长、高WBC计数水平是脑出血早期EN患者并发误吸的危险因素，床头抬高30°～45°是脑出血早期EN患者并发误吸的保护因素，据此构建的预测模型可较好地评估误吸发生风险。

Objective: To analyze the risk factors of early enteral nutrition(EN) complicated with aspiration and its prediction model in patients with cerebral hemorrhage. Methods: A retrospective study was conducted on 158 cerebral hemorrhage patients who received early EN support from January 2021 to February 2024 in our hospital. Patients were divided into aspiration group(61 cases) and non-aspiration group(97 cases) based on the occurrence of aspiration. Clinical data were collected, and Logistic regression analysis was performed to identify factors affecting aspiration during early EN. A prediction model was constructed, and receiver operating characteristic(ROC) curve was used to evaluate the model's predictive performance. Hosmer-Lemeshow test and calibration curve were used to assess model calibration. Results: The proportion of high nutritional risk, the proportion of coma, the proportion of EN support form continuous, the proportion of nasal feeding tube diameter 3.5 mm, the length of nasal feeding tube insertion and the level of white blood cell count(WBC) count in aspiration group were higher than those in non-aspiration group, and the proportion of bed head elevation 30°-45° was lower than that in the non-aspiration group(P<0.05). Logistic regression analysis identified nutritional risk(OR=8.358, 95%CI 1.179-59.245), consciousness state(OR=7.557, 95%CI 1.241-46.012), bed head elevation(OR=0.102, 95%CI 0.012-0.873), nasogastric tube insertion length(OR=1.085, 95%CI 1.016-1.159), nasogastric tube diameter(OR=8.150, 95%CI 1.217-54.582), and WBC count(OR=2.741, 95%CI 1.641-4.577) were influencing factors for aspiration during early EN(P<0.05). The prediction model constructed by these influencing factors was evaluated using ROC curve analysis, which showed area under the curve(AUC) of 0.949, with sensitivity of 0.918 and specificity of 0.825. Hosmer-Lemeshow test showed χ²=12.175, P=0.144, and the calibration curve showed close alignment between the correction curve and ideal curve, with an absolute mean error of 0.014. Conclusion: High nutritional risk, coma, nasal feeding tube diameter of 3.5 mm, longer length of nasal feeding tube insertion, and high WBC count level are risk factors for aspiration in EN patients with early intracerebral hemorrhage. Bed head elevation of 30°-45° is protective factor for aspiration in EN patients with early intracerebral hemorrhage. The prediction model based on these factors can effectively assess the risk of aspiration.

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