急性胰腺炎患者再喂养综合征风险预测模型的构建及护理启示

doi:10.3761/j.issn.0254-1769.2024.13.011

摘要/Abstract

摘要：

目的探讨急性胰腺炎患者发生再喂养综合征的危险因素，建立风险预测模型并进行验证，以指导临床护理实践。方法采用便利抽样法，选取2021年1月—2023年3月江西省赣州市某三级甲等医院收治的260例急性胰腺炎患者作为调查对象，依据患者是否发生再喂养综合征将其分为再喂养综合征组和非再喂养综合征组，对相关资料进行单因素及Logistic回归分析，构建风险预测模型并进行验证。结果 260例急性胰腺炎患者中，有56例发生再喂养综合征，发生率为21.54%。Logistic回归分析结果显示，患者胃肠道功能分级高、再喂养中额外补充蛋白质、营养风险评估量表评分高和营养液滴注速度快是急性胰腺炎患者发生再喂养综合征的独立危险因素（OR>1，P<0.05）；再喂养前血清前白蛋白浓度、血清白蛋白浓度高是独立保护因素（OR<1，P<0.05）。模型回归方程为Logit（P）=1.549 × 胃肠道功能分级+1.899 × 再喂养中额外补充蛋白质+0.683 × 营养风险评估量表评分+0.031 × 营养液滴注速度-0.018 × 再喂养前血清前白蛋白浓度-0.038 × 再喂养前血清白蛋白浓度-9.836。Hosmer-Lemeshow拟合优度检验结果显示，χ²=8.019，P=0.432，受试者操作特征曲线下面积为0.915（P<0.001，95%CI为0.865~0.965），灵敏度为83.30%，特异度为87.90%，最大约登指数为0.712。结论该研究构建的急性胰腺炎患者再喂养综合征风险预测模型具有较好的准确度和区分度，可作为护理人员预测急性胰腺炎患者再喂养综合征发生风险的评估工具，可为其及时制订个体化预防策略提供参考。

关键词: 急性胰腺炎, 再喂养综合征, 危险因素, 风险预测模型, 护理

Abstract:

Objective To explore the risk factors affecting the occurrence of refeeding syndrome in patients with acute pancreatitis，to establish a risk prediction model and verify it，and provide enlightenment for clinical nursing management. Methods A total of 260 patients with acute pancreatitis in our hospital from January 2021 to March 2023 were selected and divided into a refeeding syndrome group and a non-refeeding syndrome group according to whether refeeding syndrome occurred. Logistic regression analysis was performed on the related factors，and the risk model of array diagram was constructed and verified. Results Of the 260 patients with acute pancreatitis，56 developed refeeding syndrome，with an incidence of 21.54%. The results of factor analysis showed that high grade of gastrointestinal function，additional protein supplementation during feeding，NRS score and rapid infusion of nutrient solution were independent risk factors for refeeding syndrome in patients with acute pancreatitis （OR>1，P<0.05）. High serum prealbumin concentration before feeding and high serum albumin concentration before feeding were independent protective factors（OR<1，P<0.05）. The results of Hosmer-Lemeshow goodness-of-fit test showed that χ²=8.019，P=0.432；the area under the ROC curve was 0.915（P<0.001，95%CI：0.865~0.965）；the sensitivity was 83.30%；the specificity was 87.90%；the maximum Youden index was 0.712. The model regression equation Logit（P）=1.899 × additional protein supplementation in feeding+1.549 × gastrointestinal function classification+0.683 × NRS score+0.031 × nutrient solution infusion rate-0.018×prefeeding serum albumin-0.038 × prefeeding serum albumin-9.836. Conclusion The risk prediction model of refeeding syndrome in patients with acute pancreatitis established in this study has good accuracy and discrimination，which can predict the risk of refeeding syndrome in patients with acute pancreatitis for clinical nursing staff and formulate individualized prevention strategies as soon as possible.

Key words: Acute Pancreatitis, Refeeding Syndrome, Risk Factors, Risk Prediction Model, Nursing Care

何红梅, 喻芳, 林丽华, 舒芳. 急性胰腺炎患者再喂养综合征风险预测模型的构建及护理启示[J]. 中华护理杂志, 2024, 59(13): 1608-1615.

HE Hongmei, YU Fang, LIN Lihua, SHU Fang. Construction of a risk prediction model for refeeding syndrome in patients with acute pancreatitis and its nursing implications[J]. Chinese Journal of Nursing, 2024, 59(13): 1608-1615.

图/表 5

表1 急性胰腺炎患者的一般资料及再喂养综合征危险因素的单因素分析结果（n=260）

Table 1 General data of patients with acute pancreatitis and results from univariate analysis of risk factors for refeeding syndrome（n=260）

表2 自变量赋值方式

Table 2 Value assignment of independent variables

表3 急性胰腺炎患者再喂养综合征危险因素的Logistic回归分析结果（n=260）

Table 3 Logistic regression analysis of risk factors for refeeding syndrome in patients with acute pancreatitis（n=260）

图1 急性胰腺炎患者发生再喂养综合征的风险预测模型列线图

Figure 1 Risk warning model nomogram of refeeding syndrome in patients with acute pancreatitis

图2 急性胰腺炎患者发生再喂养综合征风险预测模型内部验证的受试者操作特征曲线

Figure 2 Validation of ROC curve of risk warning model for refeeding syndrome in patients with acute pancreatitis

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