ICU患者早期肠内营养治疗发生误吸的列线图风险预测模型建立与验证

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中图分类号：R151.41 文献标志码：A DOI：10.11958/20250625

Establishment and validation of a column chart risk prediction model for aspiration in early enteral nutrition therapy of ICU patients

WANG Haixia，HE Fei，ZHU Congmei， WANG Jing △Corresponding Author E -mail： 1977335804@qq.com

Abstract：ObjectiveTo investigate therisk factors of aspiration during earlyenteral nutrition （EEN）support treatmentinpatients in intensivecareunit （ICU）andestablishandvalidatethecorresponding nomogramrisk prediction model.MethodsAtotalof 348 ICUpatients who receivedEEN between June 2022 and May 2024 were enrolled and divided into the aspiration group （n=74） and the non-aspiration group （ n =274）based on the occurrence of aspiration. Clinical datawerecolected includedage，sex，bodymassindex （BMI），historyof diabetes，endotracheal intubation/mechanical ventilationstatus，plasmaalbumin （ALB）levels within24hafteradmision toICU，disease type （severe pneumonia/stroke/ septic shock），onsciousneslevel（GlasgowComaScale，GCS），APAHEIsore，nasogastric tubeinsertiondepthuion volume，nutritional risk （NRS2OO2 score≥3indicatinghighrisk），andnutritionmode（nasogastric/nasointestinal tube）. Logistic regression wasusedtoidentifyriskfactors ofaspiration，andanomogramprediction model wasconstructedusng R software.Externalvalidationwasperformedon72EEN-treatedICUpatientsadmitedbetweenJune2O24andJanuary2025. ResultsLogisticregression identifiedage （OR=2.701，95% CI：1.633-4.467），APACHEI score （OR=2.125，95%CI： 1.13-3.987），consciousnesslevel （OR=2.826，95%Cl：1.617-4.940），nasogastric tube insertion depth （OR=1.01，95%Cl： 1.006-1.136）and nutritional risk（OR=8.996，95%CI： 5.017-16.132）were independent risk factors for aspiration（all P<0.05）.Anomogram incorporating thesefactors was developed，convertingcumulative scores into individualizedaspiration risk probabilities.Themodel demonstratedstrongpredictiveperformance ininternalvalidation （AUC=0.860，calibration curve slope=0.93O）andexternalvalidation （AUC=0.831）.Decisioncurveanalysis （DCA）confirmed significantclinical net benefitsacrossrisk thresholds，supporting itspractical utility.ConclusionThe nomogram model exhibits good discriminationandaccuracy，providingavaluable toolforindividualizedaspirationriskassessmentinICUpatientsreceiving EEN.

KeyWords： enteral nutrition;respiratory;aspiration; nomogram; intensive care unit; predictive model

重症监护病房（ICU）的患者常常由于疾病的严重性和多样性，需要营养支持以维持生命体征和改善预后。（剩余10815字）