摘要
目的探讨ICU脓毒症患者发生再喂养综合征(RFS)的相关危险因素,以此为基础建立RFS的预测模型。方法回顾性分析昆明医科大学第一附属医院ICU 2020年11月至2022年1月期间收治的202例脓毒症患者的临床资料,根据“ASPEN关于RFS共识建议中”诊断标准,将患者是否发生RFS,分为RFS组(n=141)和非RFS组(n=61);比较2组间性别、体重指数(BMI)、营养风险筛查、营养方式、相关危重评分、腹内压(IAP)、相关实验室检查及用药的差异。选取统计学方法中的单因素和多因素Logistic回归分析筛选出ICU脓毒症患者发生RFS的独立危险因素,根据分析结果建立一种预测模型,绘制出受试者工作特征曲线(ROC)评价RFS的预测模型对ICU脓毒症患者发生RFS的预测价值。结果202例脓毒症患者相关资料分析,单因素分析结果显示:体重指数(BMI)、白蛋白(ALB)、前白蛋白(PA)、肌酐-身高指数(CHI)、血清钠(Na+)、血清钾(K^(+))、血清镁(Mg^(2+))、血清磷(P^(-))、白介素-6(IL-6)、空腹血糖(FBG)、维生素B1(VitB1)、糖化血红蛋白(HbA1c)、是否使用利尿剂、是否使用胰岛素等指标差异有统计学意义(P<0.05);多因素分析结果显示:利尿剂的使用、BMI、CHI、血K^(+)、FBG、VitB1是ICU脓毒症患者发生RFS独立危险因素。结论以多因素筛选出独立危险因素为基础,建立预测模型表达式为:Logit=1.39×利尿剂+0.15×BMI-0.14×CHI+0.75×血K^(+)-0.16×FBG+0.78×VitB1-2.94。通过回归分析建立的预测模型一致性强,联合预测有较好的预测价值。
Objective To explore the relevant risk factors for Refeeding Syndrome(RFS)in ICU patients with sepsis,and to establish a prediction model of RFS based on the selected risk factors.Methods The clinical data of sepsis patients admitted to the ICU of the First Affiliated Hospital of Kunming Medical University from November 2020 to January 2022 were studied retrospectively.Finally,202 patients were selected according to the inclusion and exclusion criteria.According to the diagnosis criteria of ASPEN Consensus Recommendations(2020)for RFS,the patients were divided into two groups:RFS group(n=141)and non-RFS group(n=61)on the basis of whether occur of RFS.The differences of gender,body mass index(BMI),nutrition risk screening,nutritional way,related critical score,intraabdominal pressure(IAP),relevant laboratory tests,biochemical indexes and pharmacy were compared between the two groups.The independent risk factors of RFS in ICU patients with sepsis were screened by single factor and multivariate logistic regression analysis,and a prediction model was established according to the results of the analysis.The predictive value of the prediction model for RFS in ICU patients with sepsis was evaluated by drawing the receiver operating characteristic curve(ROC)of the subjects.Results After analyzing the relevant data of 202 sepsis patients,the results of monofactor logistic regression analysis showed:Body mass index(BMI),albumin(ALB),prealbumin(PA),creatinine-height index(CHI),serum sodium(Na^(+)),serum potassium(K^(+)),serum magnesium(Mg^(2+)),serum phosphorus(P^(-)),interleukin-6(IL-6),fasting blood glucose(FBG),vitamin B1(VitB1),glycosylated hemoglobin(HbA1c),use of diuretics,use of insulin and other indicators were significantly different(P<0.05).And multivariate analysis showed that the use of diuretics,BMI,CHI,serum K^(+),FBG,and VitB1 were independent risk factors for RFS in ICU sepsis patients.Conclusions Based on the independent risk factors in the multivariate screening,the prediction model expression is establish
作者
王虹
杨德兴
王强
周维钰
唐杰夫
王振方
付凯
刘圣哲
刘荣
Hong WANG;Dexing YANG;Qiang WANG;Weiyu ZHOU;Jiefu TANG;Zhenfang WANG;Kai FU;Shengzhe LIU;Rong LIU(Dept.of ICU,Yuxi People’s Hospital,Yuxi Yunnan 653100;Dept.of Internal Emergency,The 1st People’s Hospital of Yunnan,Kunming Yunnan 650034;Dept.of ICU,The 1st Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650032,China)
出处
《昆明医科大学学报》
CAS
2022年第11期44-51,共8页
Journal of Kunming Medical University
基金
云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目(202101AY07001-019)
昆明医科大学研究生创新基金资助项目(2021S049)。
