基于Lasso回归的重型颅脑损伤患者肠内营养相关性腹泻影响因素分析  

Analysis of influencing factors of enteral nutrition-associated diarrhea in patients with severe craniocerebral injury based on lasso regression

作　　者：张坤秀 吴晓英[1] 卢雨薇 沈正泽[2] 申思蓉 曾凡平[3] 廖娟[4] Zhang Kunxiu;Wu Xiaoying;Lu Yuwei;Shen Zhengze;Shen Sirong;Zeng Fanping;Liao Juan(Infection Management Department,The Affiliated Yongchuan Hospital of Chongqing Medical University,Chongqing 402160,China;Pharmacy Department,The Affiliated Yongchuan Hospital of Chongqing Medical University,Chongqing 402160,China;Neurosurgery Department,The Affiliated Yongchuan Hospital of Chongqing Medical University,Chongqing 402160,China;Central Laboratory,The Affiliated Yongchuan Hospital of Chongqing Medical University,Chongqing 402160,China)

机构地区：[1]重庆医科大学附属永川医院感染管理科,重庆402160 [2]重庆医科大学附属永川医院药剂科,重庆402160 [3]重庆医科大学附属永川医院神经外科,重庆402160 [4]重庆医科大学附属永川医院中心实验室,重庆402160

出　　处：《保健医学研究与实践》2024年第8期71-77,共7页Health Medicine Research and Practice

基　　金：重庆市科卫联合医学科研项目(2022MSXM047);重庆市永川区技术创新与应用发展项目(2024cycxfz30002)。

摘　　要：目的 探讨重型颅脑损伤患者发生肠内营养相关性腹泻的影响因素,为降低肠内营养相关性腹泻发生率提供理论依据。方法 选取2022年1月—2024年5月在重庆市某三级甲等综合医院行肠内营养治疗的262例重型颅脑损伤患者为研究对象,根据是否发生肠内营养相关性腹泻分为腹泻组(n=102)和非腹泻组(n=160)。采用单因素分析和Lasso回归筛选影响因素,通过二分类logistic回归分析重型颅脑损伤患者发生肠内营养相关性腹泻的独立影响因素。结果 2组患者在急性生理与慢性健康(APACHE II)评分、ICU住院时长、禁食时长、是否机械通气、是否感染、抗生素使用种类数、抗生素使用时长、是否使用质子泵抑制剂、是否使用胃肠道促动力药、是否使用口服钾制剂、是否使用血管活性药物、血管活性药物使用种类数、入院时的白蛋白水平、肠内营养前的白蛋白水平14个方面上的差异具有统计学意义(P<0.05)。APACHE II评分(OR=1.117,95%CI:1.040~1.199)、机械通气(OR=2.695,95%CI:1.064~6.827)、抗生素使用种类数(OR=1.888,95%CI:1.333~2.673)、使用胃肠道促动力药(OR=2.620,95%CI:1.222~5.620)和肠内营养前的白蛋白水平(OR=0.883,95%CI:0.812~0.960)是重型颅脑损伤患者发生肠内营养相关性腹泻的独立影响因素。结论 重型颅脑损伤患者的肠内营养相关性腹泻发生率较高,临床应对APACHE II评分高、行机械通气、使用胃肠道促动力药、使用多种抗生素的重型颅脑损伤患者采取相应的措施,以降低肠内营养相关性腹泻的发生率。Objective To explore the factors affecting enteral nutrition-associated diarrhea in patients with severe craniocerebral injury,providing a theoretical basis for reducing the incidence of enteral nutrition-associated diarrhea.Methods A total of 262 patients with severe craniocerebral injury who underwent enteral nutrition treatment from January 2022 to May 2024 at a grade A tertiary hospital in Chongqing were selected as the study participants,who were assigned to diarrhea group(n=102)and non-diarrhea group(n=160)based on the occurrence of enteral nutrition-associated diarrhea.Univariate analysis and Lasso regression were used to screen influencing factors.Moreover,binary logistic regression analysis was conducted to determine the independent influencing factors for enteral nutrition-associated diarrhea in patients with severe craniocerebral injury.Results Differences in Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scores,length of ICU stay,fasting duration,use or non-use of mechanical ventilation,presence or absence of infection,types of antibiotics used,duration of antibiotic use,use or nonuse of proton pump inhibitors,use or non-use of gastrointestinal prokinetic drugs,use or non-use of oral potassium preparations,use or non-use of vasoactive drugs,types of vasoactive drugs used,and albumin levels at admission and before enteral nutrition in the two groups were statistically significant(P<0.05).APACHE II score(OR=1.117,95%CI:1.040-1.199),mechanical ventilation(OR=2.695,95%CI:1.064-6.827),number of antibiotic types(OR=1.888,95%CI:1.333-2.673),use of gastrointestinal prokinetic drugs(OR=2.620,95%CI:1.222-5.620),and albumin levels before enteral nutrition(OR=0.883,95%CI:0.812-0.960)were independent influencing factors for enteral nutrition-associated diarrhea in patients with severe craniocerebral injury.Conclusion The incidence of enteral nutrition-associated diarrhea in patients with severe craniocerebral injury remains relatively high.Clinically,measures should be taken for patients with high APA

关 键 词：重型颅脑损伤 肠内营养相关性腹泻 危险因素 

分 类 号：R651.1[医药卫生—外科学]