先天性心脏病患儿术后喂养不耐受风险预测模型构建  

Development of feeding intolerance prediction model in children with congenital heart disease after cardiac surgery

作　　者：岳明叶 史嘉玮[1] 王慧华[1] 胡玉婷 熊莉娟 Yue Mingye;Shi Jiawei;Wang Huihua;Hu Yuting;Xiong Lijuan(Department of Cardiovascular Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院心脏大血管外科,湖北武汉430022 [2]华中科技大学同济医学院护理学院 [3]华中科技大学同济医学院附属协和医院护理部,湖北武汉430022

出　　处：《护理学杂志》2025年第8期11-16,共6页Journal of Nursing Science

摘　　要：目的构建先天性心脏病患儿术后喂养不耐受的风险预测模型,为识别高危患儿提供依据。方法回顾性收集265例年龄<1岁的先天性心脏病患儿的临床指标数据进行模型训练和预测,预测模型包括逻辑回归、支持向量机、随机森林、决策树、梯度提升决策树、极限梯度提升和朴素贝叶斯共7种机器学习算法,并进行评价和比较。采用准确率、精确率、召回率、F1值和受试者工作特征曲线下面积(AUC)评价模型性能。结果先天性心脏病患儿术后喂养不耐受发生率为49.4%。7个机器学习模型中,极限梯度提升模型表现最好,AUC为0.914(95%CI:0.849,0.967)。血管活性药物评分、喂养前机械通气时间、喂养启动时间和月龄等10个因素是先天性心脏病患儿术后发生喂养不耐受的影响因素。结论先天性心脏病患儿术后喂养不耐受发生率较高,极限梯度提升模型构建的喂养不耐受风险预测模型具有较好的性能,可能有助于临床决策和优化个体化肠内营养管理。Objective To develop a model for predicting feeding intolerance risk in children with congenital heart disease(CHD)after cardiac surgery,and to provide reference for identifying children at high risk.Methods A retrospective cohort study of 265 children younger than 1 year with CHD was conducted.Clinical data were collected for model training,and seven machine learning algorithms were performed including logistic regression,support vector machine,random forest,decision tree,gradient boosting decision tree,extreme gradient boosting,and plain Bayesian.Accuracy,precision,recall,F-score and the area under the receiver operating characteristic curve(AUC)were used to evaluate the model performance.Results The incidence of feeding intolerance in children with CHD after cardiac surgery was 49.4%.Among the seven machine learning algorithms,the performance of the extreme gradient boosting was the best,with an AUC of 0.914(95%CI:0.849,0.967).Ten factors including vasoactive-inotropic score,duration of mechanical ventilation before feeding,feeding initiation time,age,etc.affected feeding intolerance in children with CHD.Conclusion Feeding intolerance is relatively high in children with CHD after cardiac surgery.The prediction model developed based on the extreme gradient boosting demonstrates good performance,which may contribute to clinical decision-making and optimization of individualized enteral nutrition management.

关 键 词：儿童 婴儿 先天性心脏病 喂养不耐受 机器学习 肠内营养 预测模型 护理 

分 类 号：R473.72[医药卫生—护理学] R541.1[医药卫生—临床医学]