ICU患者肠内营养相关性腹泻列线图预测模型构建  

Construction of a nomogram prediction model for enteral nutrition-associated diarrhea in ICU patients

作　　者：谢文亮 张清[1] Xie Wenliang;Zhang Qing(School of Nursing,Tianjin Medical University,Tianjin 300070,China)

机构地区：[1]天津医科大学护理学院,天津300070

出　　处：《护理学杂志》2022年第12期83-87,共5页Journal of Nursing Science

摘　　要：目的建立ICU患者肠内营养相关性腹泻风险预测模型,为预防性护理干预提供依据。方法回顾分析335例ICU行肠内营养治疗的患者资料,采用单因素和多因素logistic分析肠内营养相关性腹泻的独立危险因素,构建风险预测模型,用列线图展示预测模型。采用Bootstrap法进行内部验证,受试者工作特征(ROC)曲线评价模型区分度,采用校准曲线评价模型准确度,采用临床决策曲线(DCA)评价模型的有效性。结果163例(48.66%)ICU患者发生肠内营养相关性腹泻。肠内营养相关性腹泻风险预测模型纳入APACHE-Ⅱ评分、口服钾制剂时间、使用胃肠动力药、禁食时间和白蛋白水平5个预测因子。预测模型的ROC曲线下面积为0.940,灵敏度为81.82%,特异度为91.18%,准确度为86.57%,最大Youden指数0.73所对应的预测临界值为122分。校准曲线为斜率接近于1的直线,准确度良好。临床决策曲线显示模型的净获益值较高。结论该模型可以有效预测ICU患者肠内营养相关性腹泻的发生,且评价指标在开始行肠内营养时即可获得,可为ICU医护人员及时采取预防性护理干预提供借鉴。Objective To establish a risk prediction model for enteral nutrition-associated diarrhea in ICU patients.Methods Data of 335 ICU patients who received enteral nutrition therapy were retrospectively collected.The independent risk factors for enteral nutrition-associated diarrhea were analyzed using univariate tests and multivariate logistic regression model to construct a risk prediction model,which was displayed with a nomogram.Bootstrap method was used for internal verification,the receiver operating characteristic(ROC)curve was used to evaluate the discriminability of the model,the calibration curve was used to evaluate the accuracy of the model,and the clinical decision curve(DCA)was used to evaluate the effectiveness of the model.Results The risk prediction model for enteral nutrition-associated diarrhea included such 5 factors as APACHE-Ⅱscore,days of oral potassium preparations,use of gastrointestinal motility drug,fasting days,and albumin level.The area under the ROC curve of the prediction model was 0.940,the sensitivity was 81.82%,the specificity was 91.18%,and the accuracy was 86.57%.The maximum Youden index was 0.73,which pointed to a cutoff value of 122 points.The calibration curve was a straight line with a slope close to 1,meaning good accuracy.The clinical decision curve showed that the net benefit(NB)value of the model was high.Conclusion This model can effectively predict the occurrence of enteral nutrition-associated diarrhea in ICU patients,and the indexes can be obtained when enteral nutrition is started,which can provide reference for ICU medical staff to take preventive nursing intervention in time.

关 键 词：肠内营养 ICU 腹泻 APACHE-Ⅱ评分 胃肠动力药 白蛋白水平 预测模型 列线图 

分 类 号：R47[医药卫生—护理学] R472.2[医药卫生—临床医学]