重症患者ICU获得性代谢性碱中毒的危险因素分析及风险预测模型构建  

Risk factors and predictive model for ICU-acquired metabolic alkalosis in critically ill patients

作　　者：秦进成 程玉梅 沈锋 李伟 李书文 肖川 李璐 李清 刘颖 何娟 QIN Jincheng;CHENG Yumei;SHEN Feng;LI Wei;LI Shuwen;XIAO Chuan;LI Lu;LI Qing;LIU Ying;HE Juan(Medicine Department of Intensive Care,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学附属医院重症医学科,贵州贵阳550004

出　　处：《贵州医科大学学报》2024年第9期1341-1347,共7页Journal of Guizhou Medical University

基　　金：国家自然科学基金(82160365);贵州省卫生健康委科学技术项目(gzwkj2021-034);贵州医科大学附属医院国家自然科学基金培育项目(gyfynsfc[2020]-9)。

摘　　要：目的观察重症医学科(ICU)患者在治疗期间发生代谢性碱中毒(代碱)的情况,探讨发生代碱的高危因素并建立风险预测模型。方法收集综合ICU入住院患者的一般临床资料(性别、年龄、基础疾病等),记录发生酸碱紊乱类型、发生代碱患者疾病分布,比较代碱组与非代碱组患者的一般临床资料、用药情况及实验室指标,单因素分析可能导致代碱的危险因素;将有统计学意义的危险因素纳入多因素logistic回归分析,根据OR值建立预测ICU发生代碱的模型,以ROC曲线来评价模型的预测效果。结果根据纳排标准最终纳入507例患者,其中发生代碱(代碱组)172例(33.93%)、未发生任何酸碱紊乱(非代碱组)100例(19.72%);发生代碱时间的中位数为3(2,4)d,代碱患者ICU住院期间病死率为8.1%,该组患者ICU住院时间和机械通气时间较非代碱组明显延长(P<0.05);多因素logistic回归分析显示,胃肠减压、利尿剂及碱性药的使用、高血Na(>143 mmol/L)为发生ICU获得性代碱的独立危险因素(P<0.05),其风险评分模型中对应的分值为4、3、2、1分;模型在ROC曲线下面积为0.799、灵敏度79.1%、特异度73.0%。结论胃肠减压、利尿剂、碱性药、高血Na(>143 mmol/L)是重症患者在ICU住院期间发生代碱的独立危险因素。Objective To investigate the incidence of metabolic alkalosis(MA)in intensive care unit(ICU)patients,identify risk factors,and develop a predictive model.Methods Clinical data(gender,age,underlying diseases,etc.)from patients admitted to a comprehensive ICU were collected,including gender,age,underlying conditions,acid-base disorders,and disease distribution in MA patients.The MA and non-MA groups were compared for clinical characteristics,medication use,and laboratory parameters.Univariate analysis identified potential risk factors,which were then subjected to multivariate logistic regression.A predictive model for ICU-acquired MA was constructed based on odds ratios(ORs)and evaluated using receiver operating characteristic(ROC)curve analysis.Results Of 507 included patients,172(33.93%)developed MA,while 100(19.72%)maintained normal acid-base status.Median time to MA onset was 3(2,4)days.In-ICU mortality for MA patients was 8.1%.The MA group had significantly longer ICU stays and mechanical ventilation duration(P<0.05).Multivariate analysis revealed gastrointestinal decompression,diuretic and alkaline drug use,and hypernatremia(>143 mmol/L)as independent risk factors for ICU-acquired MA(P<0.05).The risk scoring model assigned 4,3,2,and 1 points to these factors,respectively.The model's area under the ROC curve was 0.799,with 79.1%sensitivity and 73.0%specificity.Conclusion Gastrointestinal decompression,diuretic use,alkaline drug administration,and hypernatremia are independent risk factors for MA in critically ill ICU patients.

关 键 词：重症患者 代谢性碱中毒 危险因素 风险预测模型 

分 类 号：R114[医药卫生—卫生毒理学]