不同喂养不耐受变化轨迹外科危重症患者预后及影响因素的多中心研究  

Prognosis and influencing factors in critically ill surgical patients of different feeding intolerance trajectories:a multicentre study

作　　者：郑恒宇 李嘉琪 左俊焘 蔡丽娜 林佳佳 柯路 叶向红 Zheng Hengyu;Li Jiaqi;Zuo Juntao;Cai Lina;Lin Jiajia;Ke Lu;Ye Xianghong(Department of General Surgery,Nanjing Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210002,China;Departmentof Critical Care Medicine,Nanjing Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210002)

机构地区：[1]南京大学医学院附属金陵医院普通外科,南京210002 [2]南京大学医学院附属金陵医院重症医学科,南京210002

出　　处：《中华消化外科杂志》2023年第11期1314-1321,共8页Chinese Journal of Digestive Surgery

基　　金：军事医学创新工程项目(18CXZ040)。

摘　　要：目的探讨不同喂养不耐受变化轨迹外科危重症患者预后及影响因素.方法采用回顾性队列研究方法.收集2018年3月至2019年7月中国重症营养临床研究小组-NEED数据库中69家医学中心收治的354例外科危重症患者的临床资料;男247例,女107例;年龄为58(46,68)岁.根据354例患者喂养不耐受变化轨迹模型,分为无喂养不耐受、喂养不耐受下降、喂养不耐受持续分别为164、49、141例.观察指标:(1)不同喂养不耐受变化轨迹患者一般情况.(2)不同喂养不耐受变化轨迹患者营养治疗情况.(3)不同喂养不耐受变化轨迹患者生存情况.(4)外科危重症患者预后影响因素分析.正态分布的计量资料以(x)±s表示,组间比较采用单因素方差分析;偏态分布的计量资料以M(Q1,Q3)表示,组间比较采用Kruskal-Wallis秩和检验.计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验.等级资料比较采用Kruskal-Wallis秩和检验.两两比较采用Bonferroni校正.根据Stata17.0统计软件中Traj插件构建组基轨迹模型,最佳轨迹模型采用贝叶斯信息准则、平均后验概率参数评价.采用Kaplan-Meier法绘制生存曲线并计算生存率,Log-Rank检验进行生存分析.采用COX比例风险回归模型进行单因素和多因素分析.结果(1)不同喂养不耐受变化轨迹患者一般情况.354例外科危重症患者中,行肠内营养治疗257例、行肠内营养+肠外营养治疗97例,急性生理与慢性健康(APACHEⅡ)评分为17(13,21)分,序贯性器官功能衰竭(SOFA)评分为6(5,8)分,改良危重症营养风险(mNUTRIC)评分为4(2,5)分,合并症数量为2(1,3)个,急性胃肠损伤分级为Ⅰ级、Ⅱ级、Ⅲ级分别为293、55、6例,行机械通气、连续肾替代治疗、血管活性药物使用分别为224、17、61例.354例患者喂养不耐受发生率呈先上升后下降趋势,第3天发生率达峰值为25.42%(90/354),7d内发生率为53.67%(190/354)o 354例外科危重症患者中,无喂养Objective To investigate the prognosis and influencing factors in critically ill surgical patients of different feeding intolerance trajectories.Methods The retrospective cohort study was conducted.The clinical data of 354 critically ill surgical patients who were admitted to 69 medical centers in the Chinese Critical Care Nutrition Trials Group-NEED database from March 2018 to July 2019 were selected.There were 247 males and 107 females,aged 58(46,68)years.According to the trajectory model of feeding intolerance change,354 patients were divided into 3 categories as feeding intolerance,decreased feeding intolerance,continuous feeding intolerance,including 164,49,141 cases respectively.Observation indicators:(1)general situations of patients of different feeding intolerance trajectories;(2)treatment of patients of different feeding intolerance trajectories;(3)survival of patients of different feeding intolerance trajectories;(4)analysis of prognostic factors in critically ill surgical patients.Measurement data of normal distribution were expressed as Mean+SD,and one-way analysis of variance was used for comparison between groups.Measurement data of skewed distribution were expressed as M(Q,Q.),and Kruskal-Wallis rank sum test was used for comparison between groups.Count data were expressed as absolute numbers or percentages,and chi-square test was used for comparison between groups.Ordinal data were compared using the Kruskal-Wallis rank sum test.Bonferroni correction was used for pairwise comparison.Group-based trajectory model was constructed according to Traj plug-in in Stata17.0 statistical software,and the optimal trajectory model was evaluated by Bayesian information criterion and average posterior probability parameter.The Kaplan-Meier method was used to draw the survival curve and calculate the survival rate,and Log-Rank test was used for survival analyses.Univariate and multivariate analyses were conducted using the cox proportional hazard regression model.Results(1)General situations of patients of diffe

关 键 词：危重病 手术 喂养不耐受 组基轨迹模型 预后 影响因素 

分 类 号：R459.7[医药卫生—急诊医学]