急性加重期慢性阻塞性肺疾病患者有创机械通气期间营养风险及影响因素分析  

Risk of malnutrition during invasive mechanical ventilation in patients with AECOPD and analysis of its affecting factors

作　　者：陈晓芳 姜艳[1] 王明月 Chen Xiao-fang;Jiang Yan;Wang Ming-yue(Department of Emergency,Shengjing Hospital Affiliated to China Medical University,Shenyang,Liaoning 110004,China;ICU,Shengjing Hospital Affiliated to China Medical University,Shenyang,Liaoning 110004,China)

机构地区：[1]中国医科大学附属盛京医院急诊科,辽宁沈阳110004 [2]中国医科大学附属盛京医院重症监护病房,辽宁沈阳110004

出　　处：《中国现代医学杂志》2023年第8期81-86,共6页China Journal of Modern Medicine

基　　金：辽宁省科学技术基金项目(No:2021-MS-01)。

摘　　要：目的探究慢性阻塞性肺疾病急性加重期(AECOPD)有创机械通气患者营养风险及影响因素分析。方法选取2020年2月—2022年2月入住中国医科大学附属盛京医院重症监护病房(ICU)需要有创机械通气支持的AECOPD患者126例,根据营养风险筛查量表(NRS)2002将患者分为有营养风险组(86例)和无营养风险组(40例)。收集患者动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、第1秒用力呼气容积占用力肺活量百分比(FEV_(1)/FVC)、残气量(RV)、白蛋白(ALB)、前白蛋白(PA)等临床资料。采用多因素一般Logistic回归分析有创机械通气AECOPD患者发生营养风险的危险因素,绘制受试者工作特性(ROC)曲线评价上述指标对有创机械通气AECOPD患者营养风险的诊断价值。结果有营养风险组PaO_(2)<60 mmHg、PaCO_(2)≥50 mmHg、FEV_(1)/FVC<50%、ALB<30.00 g/L、PA<145.00 g/L占比高于无营养风险组(P<0.05)。两组患者性别、文化程度、吸烟指数、既往病史、RV、呼吸机相关性肺炎、有创机械通气时间、ICU住院时间、再插管比较,差异无统计学意义(P>0.05)。多因素一般Logistic回归分析结果显示:PaO_(2)<60 mmHg[OR=2.862(95%CI:1.482,5.527)]、FEV_(1)/FVC<50%[OR=2.834(95%CI:2.070,3.880)]、ALB<30.00 g/L[OR=2.268(95%CI:1.032,4.984)]、PA<145.00 g/L[OR=2.282(95%CI:1.123,4.637)]是有创机械通气AECOPD患者发生营养风险的危险因素(P<0.05)。ROC曲线分析结果显示,PaO_(2)、FEV_(1)/FVC、ALB和PA联合检测的敏感性为89.1%(95%CI:0.835,0.967),特异性为95.9%(95%CI:0.856,0.978),曲线下面积为0.925(95%CI:0.870,0.980)。结论PaO_(2)、FEV_(1)/FVC、ALB、PA是有创机械通气AECOPD患者发生营养风险的独立危险因素,四项参数联合有望成为患者早期营养风险发生的预测指标。Objective To explore the risk of malnutrition during invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and to analyze its affecting factors.Methods A total of 126 AECOPD patients who were admitted to the intensive care unit(ICU)of our hospital from February 2020 to February 2022 and required invasive mechanical ventilation support were selected.According to Nutritional Risk Screening(NRS)2002,the patients were divided into risk of malnutrition group(86 cases)and non-risk of malnutrition group(40 cases).Clinical data including arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),forced expiratory volume in one second/forced vital capacity(FEV_(1)/FVC),residual volume(RV),and the levels of albumin(ALB)and prealbumin(PA)were collected.Factors affecting the risk of malnutrition in AECOPD patients undergoing invasive mechanical ventilation were analyzed by multivariable Logistic regression.The receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of the above indicators for risk of malnutrition in patients with AECOPD undergoing invasive mechanical ventilation.Results The proportions of PaO_(2)<60 mmHg,PaCO_(2)≥50 mmHg,FEV_(1)/FVC<50%,ALB<30.00 g/L and PA<145.00 g/L in the risk of malnutrition group were higher than those in the non-risk of malnutrition group(P<0.05).There was no difference in sex composition,degree of education,smoking index,past medical history,RV,incidence of ventilator-associated pneumonia,duration of invasive mechanical ventilation,length of ICU stay,or frequency of reintubation between the two groups(P>0.05).Multivariable Logistic regression analysis showed that PaO_(2)<60 mmHg[OR=2.862,(95%CI:1.482,5.527)],FEV_(1)/FVC<50%[OR=2.834,(95%CI:2.070,3.880)],ALB<30.00 g/L[OR=2.268,(95%CI:1.032,4.984)],and PA<145.00 g/L[OR=2.282,(95%CI:1.123,4.637)]were risk factors for risk of malnutrition in AECOPD patients undergoing invasive mechanical ventilation(P<0.

关 键 词：慢性阻塞性肺疾病 急性加重期 有创机械通气 营养风险 

分 类 号：R563.5[医药卫生—呼吸系统]