摘要
目的:探讨首次收入重症医学科(ICU)患者初次喂养后发生再喂养综合征(RFS)的早期危险因素,并构建预测模型,为入院早期的急危重症患者营养选择策略提供参考依据。方法:回顾性分析2020年1月1日—2021年7月31日首次收住蚌埠医学院第一附属医院ICU且符合病例入排标准患者的病例资料。根据是否并发RFS,分为RFS组和非RFS组,分析比较2组的临床数据指标,并构建RFS早期预测模型。结果:纳入分析的患者200例,分为RFS组134例,非RFS组66例,发病率为66.7%。单因素分析显示:NRS2002营养评分,APACHEⅡ评分,入院3 d是否诊断脓毒症,3 d内胰岛素应用病史,前白蛋白,尿素氮,C反应蛋白等与RFS发生相关(P<0.05)。筛选患者入院初期即可获得的危险因素并经二元logistic回归分析显示:前白蛋白、尿素氮、C反应蛋白为RFS的独立危险因素(P<0.05)。构建入院早期RFS预测模型Logit(P)=0.114X1+0.011X2-0.005X3,模型预测急危重症患者RFS发病率的ROC曲线下面积为0.742(95%CI:0.6708~0.8132),灵敏度为81.34%,特异度为57.58%。模型拟合优度显示:χ2=3.808(P>0.05)。结论:在剔除了入院初始合并肝肾功能不全的急危重症患者后,其首次喂养获得了更高的RFS发病率,脏器功能的损害或抑制了电解质水平的下降。前白蛋白、尿素氮、C反应蛋白是急危重症患者早期即可获得的危险因素指标,基于此构建的RFS风险预测模型有着良好的区分度及校准度,可以有效评估急危重症患者RFS发病风险,为医师营养策略选择提供参考意见。
Objective: To investigate the early risk factors of refeeding syndrome(RFS) after initial feeding in ICU patients admitted for the first time, and to construct a prediction model, so as to provide a reference for nutritional selection strategies of acute critically ill patients in early admission. Methods: The medical records of patients who were admitted to ICU of the First Affiliated Hospital of Bengbu Medical College for the first time from January 1, 2020 to July 31, 2021 and met the criteria for case inclusion were analyzed retrospectively. The patients were divided into RFS group and non-RFS group according to whether there were concurrent RFS. The clinical data indicators of the two groups were analyzed and compared, and the early prediction model of RFS was constructed. Results: A total of 200 cases were included in the analysis, which were divided into RFS group(134 cases) and non-RFS group(66 cases), with an incidence of 66.7%. Univariate analysis showed that NRS2002 nutrition score, APACHE Ⅱ score, diagnosis of sepsis within 3 days after admission, history of insulin use within 3 days, prealbumin, urea nitrogen and C-reactive protein were correlated with RFS(P<0.05). The risk factors obtained at the early stage of admission were screened and binary logistic regression analysis showed that prealbumin, urea nitrogen and C-reactive protein were independent risk factors for RFS(P<0.05). The early admission RFS prediction model Logit(P)=0.114X1+0.011X2-0.005X3was constructed. The area under the ROC curve of the model to predict the incidence of RFS in critically ill patients was 0.742(95%CI:0.670 8-0.813 2), the sensitivity was 81.34%, and the specificity was 57.58%. Model goodness-of-fit shows: χ~2=3.808(P>0.05). Conclusion: Excluding the acute critically ill patients with hepatic and renal insufficiency at the initial admission, there is a higher incidence of RFS after the first feeding, and the impairment of organ function may inhibit the decline of electrolyte level. Prealbumin, urea nitrogen and C-r
作者
徐阳
吴淑璐
张杰
曹云松
张亚慧
袁成
汪华学
XU Yang;WU Shulu;ZHANG Jie;CAO Yunsong;ZHANG Yahui;YUAN Cheng;WANG Huaxue(Department of Critical Care Medicine,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui,233000,China;The Institute of Acute and Critical Care Research,the First Affiliated Hospital of Bengbu Medical College)
出处
《临床急诊杂志》
CAS
2023年第1期35-40,共6页
Journal of Clinical Emergency
基金
安徽省“十三五”临床医学重点学科建设项目(No:卫科教秘2017-27号)。
关键词
重症医学科
再喂养综合征
危险因素
模型预测
department of critical care medicine
refeeding syndrome
risk factor
model prediction
