重症病人肠内营养相关性腹泻风险预测模型的系统评价  

Systematic review of risk prediction models for enteral nutrition-associated diarrhea in critically ill patients

作　　者：聂清梅[1] 孙莉莉[1] 丁治英[1] 孙磊娜[1] 温慧 NIE Qingmei;SUN Lili;DING Zhiying;SUN Leina;WEN Hui(Weifang People′s Hospital,Shandong 261000 China)

机构地区：[1]潍坊市人民医院,山东261000

出　　处：《循证护理》2025年第3期388-394,共7页Chinese Evidence-Based Nursing

基　　金：2024年潍坊市卫生健康委员会科研项目,编号:WFWSJK-2024-032。

摘　　要：目的:对肠内营养相关性腹泻的风险预测模型进行系统检索和评价,以期为构建更高质量的肠内营养相关性腹泻风险预测模型提供参考。方法:检索中国生物医学文献数据库、万方数据库、中国知网、EMbase、PubMed、CINAHL、Web of Science、the Cochrane Library中的相关文献,检索时限为建库至2024年3月1日,限定语种为英文和中文。由2名研究者独立筛选文献和提取数据,并应用预测模型研究的偏倚风险和适用性评估工具(PROBAST)对纳入研究的偏倚风险和适用性进行评价。结果:共纳入6项肠内营养相关性腹泻的风险预测模型构建研究,6个模型的受试者工作特征曲线下面积为0.732~0.940,涉及最多的预测因子是禁食时间、肠内营养日剂量、口服钾制剂时间和应用抗生素情况。整体适应性较好,偏倚风险较高,偏倚主要来自未选择合适的数据来源、样本量不足、对缺失数据关注不足和缺乏模型性能评估等。结论:现有证据表明,肠内营养相关性腹泻风险预测模型研究偏倚风险较高,正处于发展阶段;未来研究应关注对不同风险评估方法有效性的研究,构建偏倚风险低、预测性能优良、符合我国临床实践实施的风险预测模型。Objective:To systematically analyze and evaluate the prediction models for enteral nutrition-associated diarrhea,in order to provide reference for the construction of a higher quality risk prediction model for enteral nutrition-associated diarrhea.Methods:Relevant literature was searched from CBM,WanFang Database,CNKI,EMbase,PubMed,CINAHL,Web of Science and the Cochrane Library.The retrieval time was from the inception to March 1,2024 in Chinese and English.Two researchers independently screened literature and extracted data,and prediction model risk of bias assessment tool(PROBAST)was used to evaluate the risk of bias and applicability of included studies.Results:A total of 6 studies on risk prediction model construction of enteral nutrition-associated diarrhea were included,and the area under the subject operating characteristic curve of 6 models ranged from 0.732 to 0.940,and the predictors with the highest frequency were fasting days,daily doses of nutrient solution,days of oral potassium preparations,and use of antibiotics.The overall adaptability was good,and the risk of bias was high.The bias was mainly due to the lack of appropriate data sources,insufficient sample size,insufficient attention to missing data,and lack of model performance evaluation.Conclusion:Current evidence shows that the risk of bias of nutrition-associated diarrhea risk prediction model is high,and it is in the developing stage.Future research should focus on the effectiveness of different risk assessment methods,and build a risk prediction model with low risk of bias,excellent prediction performance and in line with clinical practice in China.

关 键 词：肠内营养 腹泻 预测模型 系统评价 循证护理 

分 类 号：R473[医药卫生—护理学]