老年脑梗死鼻饲患者发生吸入性肺炎的危险因素分析及预测模型构建-东南大学学报医学版

老年脑梗死鼻饲患者发生吸入性肺炎的危险因素分析及预测模型构建

作者：徐敏杨露

单位：南京市中心医院老年科, 江苏南京 210000

分类号：R743

出版年·卷·期（页码）：2024·43·第五期（704-711）

摘要：

目的: 探讨脑梗鼻饲患者发生吸入性肺炎的危险因素并构建预测模型。方法: 回顾性分析2021年6月至2023年6月期间于本院住院治疗的155例需接受鼻饲治疗的脑梗死老年患者的临床资料,根据住院期间是否出现吸入性肺炎分为吸入性肺炎组(n=71)和非吸入性肺炎组(n=84)。比较两组患者临床风险因素,确定老年脑梗死鼻饲患者发生吸入性肺炎的危险因素,根据结果构建预测模型,绘制ROC曲线分析预测模型对吸入性肺炎的预测价值。结果: 纳入155例接受鼻饲治疗的脑梗死患者,吸入性肺炎发生率为45.81%(71/155)。逐步Logistic回归分析显示置管次数1次以上(OR=2.380,95%CI 1.092~5.452)、自主咳嗽减弱或消失(OR=3.053,95%CI 1.697~8.751)、呕吐(OR=3.182,95%CI 1.304~8.186)、日鼻饲量≥1 000 mL(OR=3.318,95%CI 1.155~5.836)、镇静催眠药(OR=3.598,95%CI 1.197~7.421)、无吞咽功能训练(OR=2.062,95%CI 1.128~6.962)、格拉斯哥昏迷(GCS)评分≤12分(OR=4.649,95%CI 1.148~9.970)是老年脑梗死鼻饲患者发生吸入性肺炎的危险因素。根据上述危险因素构建风险预测模型,该模型预测老年脑梗死鼻饲患者发生吸入性肺炎的ROC曲线下面积为0.823(95% CI 0.750~0.896),敏感度和特异度分别为0.81和0.75。结论: 根据老年脑梗死鼻饲患者发生吸入性肺炎的危险因素构建的风险预测模型对老年脑梗死鼻饲患者护理有较大参考价值,且具有便利、易操作的优点,适合临床应用。

Objective: To analyze the risk factors and construct a prediction model for aspiration pneumonia in elderly patients with cerebral infarction and nasal feeding. Methods: The clinical data of 155 elderly patients with cerebral infarction who needed nasal feeding in our hospital from June 2021 to June 2023 were retrospectively analyzed. According to the presence or absence of aspiration pneumonia during hospitalization, they were divided into aspiration pneumonia group(n=71) and non-aspiration pneumonia group(n=84). The clinical risk factors were compared between the two groups to determine the risk factors of aspiration pneumonia in elderly patients with cerebral infarction and nasal feeding. The prediction model was constructed according to the results, and the receiver operating characteristic(ROC) curve was drawn to analyze the predictive value of the prediction model for aspiration pneumonia. Results: A total of 155 patients with cerebral infarction who received nasal feeding were included in this study. The incidence of aspiration pneumonia was 45.81%(71/155). Stepwise Logistic regression analysis showed that the number of catheter insertions＞1(OR=2.380, 95% CI 1.092-5.452), spontaneous cough diminished or disappeared(OR=3.053, 95%CI 1.697-8.751), vomiting(OR=3.182, 95% CI 1.304-8.186), nasal feeding quantity ≥1 000 mL(OR=3.318, 95% CI 1.155-5.836), sedative hypnotics(OR=3.598, 95% CI 1.197-7.421), without swallowing function training(OR=2.062, 95% CI 1.128-6.962), Glasgow coma scale(GCS) score ≤12(OR=4.649, 95% CI 1.148-9.970) were the risk factors of aspiration pneumonia in senile cerebral infarction patients with nasal feeding. Risk prediction model was established in accordance with the above risk factors for aspiration pneumonia in elderly patients with cerebral infarction. The area under the ROC curve of the model was 0.823(95% CI 0.750-0.896), and the sensitivity and specificity were 0.81 and 0.75, respectively. Conclusion: The risk prediction model constructed according to the risk factors of aspiration pneumonia in elderly cerebral infarction patients with nasal feeding has great reference value for the nursing of elderly cerebral infarction patients with nasal feeding, and has the advantages of convenience and easy operation, which is suitable for clinical application.

参考文献：

[1] RYU W S,HONG K S,JEONG S W,et al.Association of ischemic stroke onset time with presenting severity,acute progression,and long-term outcome:a cohort study[J].PLoS Med,2022,19(2):e1003910.
[2] FRASER S,PABST L,SMITH F.Stroke in the young[J].Curr Opin Neurol,2023,36(2):131-139.
[3] GOU L K,LI C.Qixue shuangbu decoction and acupuncture combined with western medicine in acute severe stroke patients[J].World J Clin Cases,2023,11(3):556-565.
[4] BEHARRY A,MICHEL P,FAOUZI M,et al.Predictive factors of swallowing disorders and bronchopneumonia in acute ischemic stroke[J].J Stroke Cerebrovasc Dis,2019,28(8):2148-2154.
[5] GLANCE L G,BENESCH C G,HOLLOWAY R G,et al.Association of time elapsed since ischemic stroke with risk of recurrent stroke in older patients undergoing elective nonneurologic,noncardiac surgery[J].JAMA Surg,2022,157(8):e222236.
[6] HUANG J,ZUO J,TANG X,et al.Early rehabilitation and nursing intervention(erni) accelerates the recovery of patients with ischemic stroke[J].Neurologist,2023,28(6):409-412.
[7] WANG J,WANG Y,WANG P,et al.Construction and evaluation of a nomogram prediction model for aspiration pneumonia in patients with acute ischemic stroke[J].Heliyon,2023,9(11):e22048.
[8] CHEN S,XIAN W,CHENG S,et al.Risk of regurgitation and aspiration in patients infused with different volumes of enteral nutrition[J].Asia Pac J Clin Nutr,2015,24(2):212-218.
[9] WANGEN T,HATLEVIG J,PIFER G,et al.Preventing aspiration complications:implementing a swallow screening tool[J].Clin Nurse Spec,2019,33(5):237-243.
[10] 李淑景,周晓虹,宋东庆.改良吞咽球囊扩张术联合呼吸训练对ICU老年脑卒中后吞咽障碍患者吞咽能力及吸入性肺炎的影响[J].中国老年学杂志,2022,42(8):1813-1815.
[11] BANDA K J,CHU H,KANG X L,et al.Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients:a meta-analysis[J].BMC Geriatr,2022,22(1):420.
[12] MENG P P,ZHANG S C,HAN C,et al.The occurrence rate of swallowing disorders after stroke patients in asia:a prisma-compliant systematic review and meta-analysis[J].J Stroke Cerebrovasc Dis,2020,29(10):105113.
[13] COHEN D L,ROFFE C,BEAVAN J,et al.Post-stroke dysphagia:a review and design considerations for future trials[J].Int J Stroke,2016,11(4):399-411.
[14] SCHWARZ M,COCCETTI A,MURDOCH A,et al.The impact of aspiration pneumonia and nasogastric feeding on clinical outcomes in stroke patients:a retrospective cohort study[J].J Clin Nurs,2018,27(1-2):e235-e241.
[15] 刘怡,张伟,李东泽,等.血栓炎症预后评分对老年脑卒中相关肺炎的预测价值[J].中华老年心脑血管病杂志,2022,24(9):940-943.
[16] 姜富城,黄菊梅,冯跃先,等.清醒镇静在急性缺血性脑卒中血管内治疗中的应用效果及预后影响评估[J].首都医科大学学报,2023,44(1):72-77.
[17] HANDA N,ISHIZAKI T,MITSUTAKE S,et al.Safety profile of hypnotics or sedatives on community-dwelling older adults aged 75 or older in japan:a retrospective propensity-matched cohort study[J].Int J Geriatr Psychiatry,2024,39(4):e6085.
[18] 罗玉珍,胡坚,胡秀香,等.高龄脑卒中吞咽障碍患者误吸的影响因素分析[J].护理实践与研究,2021,18(8):1144-1147.
[19] 张为民,岳盼盼,任杰,等.头项针联合对脑卒中后吞咽障碍患者吞咽功能及生活质量的影响[J].中国老年学杂志,2024,44(2):315-318.

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