摘要
目的构建并验证重症肺炎机械通气患者24 h内发生呼吸机相关膈肌功能障碍(VIDD)的风险预测模型。方法选取2021年1月至2024年3月广西中医药大学附属瑞康医院重症医学科收治的重症肺炎机械通气患者261例为研究对象,按照7∶3比例将其分为训练集(182例)和验证集(79例)。按照患者是否发生VIDD,将训练集患者分为发生组和未发生组。收集患者的基本资料,分析重症肺炎机械通气患者24 h内发生VIDD的影响因素并构建风险预测模型。受试者操作特征曲线评估模型的诊断价值,Hosmer-Lemeshow检验评估模型的拟合优度,决策曲线分析评估模型的适用性。结果训练集中80例患者发生VIDD。发生组和未发生组在入院时急性生理和慢性健康状况评估Ⅱ(APACHEⅡ)评分、血清白蛋白、机械通气天数、性别、感染、呼气末正压(PEEP)、治疗前动脉血氧分压、早期功能锻炼比较,差异有统计学意义(P<0.05)。入院时APACHEⅡ评分(OR=1.22)、PEEP(OR=2.13)、早期功能锻炼(OR=2.78)是重症肺炎机械通气患者24 h内发生VIDD的独立危险因素(P<0.05),血清白蛋白(OR=0.92)是保护因素(P<0.05)。训练集预测重症肺炎机械通气患者24 h内发生VIDD的曲线下面积为0.76,验证集为0.72。训练集和验证集中模型的拟合程度较好。训练集阈值概率在0.18~0.90时,临床净收益较高;验证集在0.05~0.60时,临床净收益较高。结论入院时APACHEⅡ评分、PEEP、早期功能锻炼和血清白蛋白是重症肺炎机械通气患者24 h内发生VIDD的影响因素。该模型在临床上具有良好的预测性和适用性。
Objective To construct and validate a risk prediction model for ventilator-induced diaphragm dysfunction(VIDD)within 24 hours in patients with severe pneumonia of mechanical ventilation.Methods A total of 261 patients with severe pneumonia who received mechanical ventilation in the Department of Critical Care Medicine,Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine from January 2021 to March 2024 were selected as study object,and they were divided into training set(182 cases)and validation set(79 cases)in a 7∶3 ratio.According to whether patients had VIDD or not,the patients in the training set were divided into occurrence group and non-occurrence group.The basic data of patients were collected,the influencing factors of VIDD occurrence within 24 hours in patients with severe pneumonia of mechanical ventilation were analyzed,and the risk prediction model was constructed.Receiver operating characteristic curve was used to evaluate the diagnostic value of the model,Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model,and decision curve analysis was used to evaluate the applicability of the model.Results VIDD occurred in 80 patients in the training set.There were significant differences in admission acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,serum albumin,days of mechanical ventilation,gender,infection,positive end-expiratory pressure(PEEP),arterial partial pressure of oxygen before treatment,and early functional exercise between occurrence group and non-occurrence groups(P<0.05).APACHEⅡscore(OR=1.22),PEEP(OR=2.13),and early functional exercise(OR=2.78)were the independent risk factors for VIDD within 24 hours in patients with severe pneumonia of mechanical ventilation(P<0.05),and serum albumin(OR=0.92)was the protective factor(P<0.05).The area under the curve of the training set was 0.76 to predict VIDD within 24 hours in patients with severe pneumonia of mechanical ventilation,and the verification was 0.72.The model of the training set and the validation set fit well.When the threshold probability of training set was 0.18-0.90,the clinical net benefit was higher;when the validation set was between 0.05-0.60,the clinical net benefit was higher.Conclusion Admission APACHEⅡscore,PEEP,early functional exercise,and serum albumin are influencing factors for VIDD within 24 hours in patients with severe pneumonia of mechanical ventilation.This model has good predictability and applicability in clinic.
作者
王鑫超
黄秋妹
张红
覃惠娟
叶桦
朱玉霞
夏生桂
骆春伶
WANG Xinchao;HUANG Qiumei;ZHANG Hong;QIN Huijuan;YE Hua;ZHU Yuxia;XIA Shenggui;LUO Chunling(Graduate School,Guangxi University of Chinese Medicine,Guangxi Zhuang Autonomous Region,Nanning530000,China;Department of Critical Care Medicine,Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine,Guangxi Zhuang Autonomous Region,Nanning530000,China;Department of Cardiothoracic and Vascular Surgery,Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine,Guangxi Zhuang Autonomous Region,Nanning530000,China)
出处
《中国医药导报》
CAS
2024年第26期130-136,共7页
China Medical Herald
关键词
重症肺炎
机械通气
呼吸机相关膈肌功能障碍
Severe pneumonia
Mechanical ventilation
Ventilator-induced diaphragm dysfunction
作者简介
通讯作者:黄秋妹。
