急性脑出血合并吞咽障碍患者营养不良风险诺谟图构建及防护对策  

Construction of risk Nomogram for malnutrition in patients with acute cerebral hemorrhage complicated with dysphagia and protective

作　　者：李亚亚 马琳 LI Yaya;MA Lin(Neurosurgery ward six,Tangdu Hospital,Second Affiliated Hospital of Air Force Medical University,Xi'an Shaanxi 710038,China)

机构地区：[1]空军军医大学第二附属医院唐都医院神经外科六病区,陕西西安710038

出　　处：《中国急救复苏与灾害医学杂志》2024年第8期1024-1029,共6页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：陕西省重点研发计划项目(编号:2018SF-277)。

摘　　要：目的 探讨急性脑出血(ACH)合并吞咽障碍患者营养不良发生率,确定有效防护对策,以降低营养不良发生风险。方法 选取2019年1月—2022年10月空军军医大学第二附属医院唐都医院收治的350例ACH合并吞咽障碍患者作为研究对象,按照7∶3比例随机分为建模组(n=245)和验证组(n=105),根据营养不良发生风险分为营养不良亚组和营养良好亚组,统计建模组患者一般资料,采用Lasso、Logistic回归方程筛选ACH合并吞咽障碍患者营养不良影响因素,构建诺谟图模型,绘制受试者工作特征曲线及曲线下面积(AUC)、校准曲线分析诺谟图预测效能。结果 350例ACH合并吞咽障碍患者中营养不良占比65.71%(230例);Lasso筛选变量及Logistic回归分析显示,入院时格拉斯哥昏迷量表(GCS)评分、入院时营养不良、营养支持、吞咽障碍程度、低蛋白血症、吞咽功能训练、年龄及糖尿病均为患者营养不良影响因素(P<0.05);在建模组绘制诺谟图模型显示,AUC为0.932,敏感度为81.50%,特异度为95.20%,表现出良好预测效能。结论 ACH合并吞咽障碍患者受入院时GCS评分、营养支持、入院时营养不良、吞咽障碍程度等因素影响,继发营养不良风险较高,临床可结合本文分析预测患者营养不良风险,并加强对症干预,改善预后。Objective To investigate the incidence of malnutrition in patients with acute cerebral hemorrhage(ACH)complicated with dysphagia,and to determine effective preventive measures to reduce the risk of malnutrition.Methods 350 cases of ACH patients with dysphagia treated in Tang Dou Hospital,Second Affiliated Hospital of Air Force Military Medical University from January 2019 to October 2022 were selected as research objects,according to 7:3.The model group(n=245)and the verification group(n=105)were randomly divided into the modeling group(n=245)and the verification group(n=105).According to the risk of malnutrition,the subgroup was divided into the malnutrition subgroup and the well-nourished subgroup.The statistical modeling group analyzed the general information of patients,screened the factors affecting malnutrition in patients with ACH and swallowing disorders using Lasso and logistic regression equations,constructed a Nomogram model,and plotted the receiver operating characteristic curve and area under the curve(AUC).Calibration curve analysis was used to evaluate the predictive performance of the Nomogram.Results Malnutrition accounted for 65.71%(230 cases)of 350 ACH patients with dysphagia.Lasso screening variables and Logistic regression analysis showed that the Glasgow Coma Scale(GCS)score at admission,malnutrition at admission,nutritional support,degree of dysphagia,hypoproteinemia,swallowing function training,age and diabetes were all influencing factors of malnutrition(P<0.05).The Nomogram model in the modeling group showed that the AUC was 0.932,the sensitivity was 81.50%,and the specificity was 95.20%,showing good prediction efficiency.Conclusion Patients with ACH and dysphagia are affected by factors such as GCS score at admission,nutritional support,malnutrition at admission,and degree of dysphagia.The risk of secondary malnutrition is higher.Clinical analysis can be combined with this study to predict the risk of malnutrition in patients,and strengthen symptomatic intervention to improve prognosis.

关 键 词：急性脑出血 吞咽障碍 营养不良 诺谟图 低蛋白血症 营养支持 

分 类 号：R743.34[医药卫生—神经病学与精神病学]