【摘要】 目的分析神经重症患者螺旋型鼻肠管幽门后置管的影响因素,并建立可视化的预测模型。方法回顾性分析2012年5月至2018年3月广东省人民医院神经ICU内放置螺旋型鼻肠管且操作前应用促胃肠动力药的重症患者。所有置管常规24 h后行床边X线评估,管端位于幽门后为置管成功。按置管结局分为成功组和失败组。统计患者的一般资料、APACHEⅡ评分、急性胃肠功能损伤(AGI)分级、治疗措施及药物使用等。采用单因素分析和多元Logistic回归分析置管成功的影响因素,并建立预测模型和Nomogram(列线图)。结果入选患者共241例,男146例,女95例,年龄中位数58岁,APACHEⅡ评分中位数20分,AGI分级中位数I级。119例置管成功,122例置管失败,总体成功率49.4%。Logistic回归分析表明影响置管的因素包括APACHEⅡ评分、镇静镇痛药、缩血管药、AGI分级。建立的预测模型和Nomogram的ROC曲线下面积为0.8002。结论 APACHEⅡ评分、镇静镇痛药、缩血管药、AGI分级影响神经重症患者螺旋型鼻肠管幽门后置管的成功率。据此建立的预测模型具有中等偏上的效能,可视化为Nomogram后,可为临床医师提供一个方便快捷的决策辅助工具。更多还原

【Abstract】 Objective To analyze the factors influencing postpyloric placement of spiral nasoenteral feeding tube(NET) in neurocritical care patients and establish a visualized prediction model. Methods Patients in Neurological Intensive Care Unit(NICU)who undertook postpyloric placement of NET after receiving prokinetics from Apr 2012 to Mar 2018 were included for retrospective analysis. The patients were divided into the success and failure group base on whether the tube tip entered into duodenum(or beyond)or not confirmed by bedside X-ray 24 hours later. The baseline data, APACHE Ⅱ score(acute physiology and chronic health evaluation Ⅱ), AGI grade(acute gastrointestinal injury), therapeutic measures and agents administered were recorded. Univariate and multivariate Logistic regression analysis was used to identify the potential factors affecting the postpyloric placement of NET. Based on those factors, a predicting model was established and visualized into an easy-to-use nomogram. Results A total of 241 patients including146 male and 95 female were enrolled for the study, with an median age of 58 years, median APACHEⅡscore of 20, median AGI of Ⅰ.The placement succeeded in 119(49.4%) of 241 patients. Logistic regression analysis demonstrated that APACHE Ⅱ score, sedatives and analgesics, vasopressors and AGI grade were among the influencing factors. A prediction model with a ROC-AUC of 0.8002 were established and visualized into a nomogram. Conclusion APACHE Ⅱ score, sedatives and analgesics, vasopressors and AGI grade are the factors influencing success of postpyloric NET placement in neurocritical care patients, which incorporate a predicting model that can be visualized into a nomogram. The nomogram provided intensivists an easy-to-use decision support tool in NET placements.更多还原