重症急性胰腺炎患者螺旋型鼻肠管幽门后喂养置管结局的可视化预测模型的构建  

Construction of visual predictive model for postpyloric feeding catheter outcomes in patients with severe acute pancreatitis

作　　者：张佳佳 潘小川[1] 梁世景[1] 韦春念 梁依 韦秀清 岑晓芳 ZHANG Jiajia;PAN Xiaochuan;LIANG Shijing;WEI Chunnian;LIANG Yi;WEI Xiuqing;CEN Xiaofang(Hechi People's Hospital,Hechi 547000,China)

机构地区：[1]河池市人民医院,广西壮族自治区河池市547000

出　　处：《护理实践与研究》2024年第7期1023-1029,共7页Nursing Practice and Research

基　　金：河池市科学技术局科技计划项目(编号:河科AB220752)。

摘　　要：目的探讨重症急性胰腺炎(SAP)患者螺旋型鼻肠管幽门后喂养置管结局的影响因素,构建可视化预测模型并进行验证。方法选择2020年1月—2023年6月医院重症监护室收治的SAP患者257例为研究对象,按螺旋型鼻肠管幽门后喂养置管成功与否分为成功组和失败组。采用单因素和Logistic多因素回归分析置管失败的风险因素,采用R4.2.1软件构建可视化风险列线图预测模型并验证。结果257例患者置管失败49例,失败率为19.07%。Logistic回归分析结果显示,APACHE II评分、腹腔内压(IAP)、机械通气、血浆白蛋白、使用胃肠动力药、使用血管活性药物、急性胃肠损伤(AGI)评分是SAP患者螺旋型鼻肠管幽门后喂养置管失败的影响因素(均P<0.05)。列线图预测模型建模组和验证组AUC分别为0.898,0.893;两组Calibration校准曲线趋近于理想曲线;列线图DCA曲线显示模型净获益高。结论APACHE II评分、IAP、机械通气、血浆白蛋白、使用胃肠动力药、使用血管活性药物、AGI评分是SAP患者螺旋型鼻肠管幽门后喂养置管失败的独立影响因素;构建的可视化列线图预测模型可预测SAP患者螺旋型鼻肠管幽门后喂养置管失败风险,具有良好的区分度,预测概率与实际概率之间一致性较高,预测效能较好,临床效益良好,有较好的临床应用价值等优点,可帮助ICU护理人员甄别置管的风险因素,为患者提供个体化干预措施,降低置管失败率。Objective To explore the influencing factors of postpyloric feeding catheter outcomes in patients with severe acute pancreatitis(SAP),to construct a visual prediction model and validate the model.Methods 257 SAP patients admitted to the intensive care unit of the hospital from January 2020 to June 2023 were selected as the study subjects,they were divided into a success group and a failure group according to the success or failure of the spiral nasoenteric pyloric postfeeding catheter.The risk factors of catheter failure were analyzed by univariate and Logistic multivariate regression,and a visual risk profile prediction model was construct and validated by R4.2.1 software.Results There were 49 cases of catheter failure,the failure rate was 19.07%of the 257 patients.The results of Logistic regression analysis showed that APACHE II score,intraperitoneal pressure(IAP),mechanical ventilation,plasma albumin,use of gastrointestinal motility drugs,use of vasoactive drugs,and acute gastrointestinal injury(AGI)score were the factors influencing the failure of feeding the post-pylori feeding catheter in SAP patients(All P<0.05).The AUC of the column chart prediction model modeling group and the validation group were 0.898 and 0.893,respectively;the calibration curves of the two groups approached the ideal curve;the column chart DCA curve showed that the net benefit of the model was high.Conclusion APACHE II score,IAP,mechanical ventilation,plasma albumin,the use of gastrointestinal motility drugs,the use of vasoactive drugs,and the AGI score are independent influencing factors for the failure of feeding the catheter after the helical naso-intestinal pylorus in SAP patients,the visualized nematogram prediction model can predict the risk of failure of feeding the catheter after the helical naso-intestinal pylorus in SAP patients,with good differentiation,high consistency between the prediction probability and the actual probability,good prediction performance,good clinical benefits,and good clinical application value,etc.,w

关 键 词：重症急性胰腺炎 螺旋型鼻肠管 幽门后喂养 置管 可视化预测模型 

分 类 号：R473.5[医药卫生—护理学]