ICU经口气管插管患者口咽分泌物微误吸风险预测模型的构建及初步验证

doi:10.3761/j.issn.0254-1769.2025.21.009

摘要/Abstract

摘要：

目的构建ICU经口气管插管患者口咽分泌物微误吸风险预测模型并进行验证，为早期识别、预防气管插管患者口咽分泌物微误吸提供评估工具。方法采用前瞻性研究方法，运用便利抽样法，于2023年1月—2025年2月，选取苏州市某三级甲等医院综合ICU的476例气管插管患者为调查对象。通过单因素分析和Logistic回归分析筛选影响ICU经口气管插管患者口咽分泌物微误吸的危险因素，构建列线图预测模型；采用重复K折交叉验证法和Bootstrap法进行模型的内部验证；运用受试者操作特征曲线下面积、校准曲线、决策曲线对模型的预测性能进行评价。结果 Logistic回归分析显示，镇静水平、有无声门下吸引气管导管、呼气末正压、是否合并脑卒中或创伤性颅脑损伤为ICU经口气管插管患者口咽分泌物微误吸发生的影响因素。预测模型的受试者操作特征曲线下面积为0.786[95%CI（0.745~0.827），P<0.001]，灵敏度为77.29%，特异度为71.26%，Hosmer-Lemeshow拟合优度检验值χ²=12.796（P=0.077）。5折和10折交叉验证显示受试者操作特征曲线下面积分别为0.765、0.772。采用Bootstrap法重复抽样1 000次检验结果显示，C指数为0.776[95%CI（0.737~0.818）]。结论该研究构建的ICU经口气管插管患者口咽分泌物微误吸风险预测模型具有良好的区分度和校准度，可辅助ICU医护人员对有创机械通气患者微误吸发生风险进行快速识别。

关键词: 重症监护病房, 插管，气管内, 口咽分泌物, 微误吸, 预测模型, 危重症护理

Abstract:

Objective To construct and validate a risk prediction model for microaspiration of oropharyngeal secretions in patients with endotracheal intubation in ICU，providing a reference for early identification and prevention of microaspiration in intubated patients. Methods Using a prospective research method and convenience sampling，476 patients with endotracheal intubation in the comprehensive ICU of a tertiary hospital in Suzhou were selected as the survey subjects from January 2023 to February 2025. The risk factors for microaspiration of oropharyngeal secretions in ICU patients with endotracheal intubation were screened through univariate analysis and logistic regression analysis，and a nomogram prediction model was constructed. The internal validation of the model was conducted using the repeated K-fold cross validation method and Bootstrap method. The predictive performance of the model was evaluated using the area under the subject operating characteristic curve，calibration curve，and decision curve. Results The logistic regression analysis showed that sedation level，the presence of a subglottic suction catheter，PEEP value，and a diagnosis of stroke or traumatic brain injury were influencing factors for microaspiration of oropharyngeal secretions in ICU patients with endotracheal intubation. The area under the receiver operating characteristic curve（AUC） of the prediction model was 0.786[95%CI（0.745~0.827），P<0.001]，with a sensitivity of 77.29% and a specificity of 71.26%. The Hosmer-Lemeshow goodness-of-fit test yielded a 2 value of 12.796（P=0.077）. Five-fold and ten-fold cross-validation revealed AUCs of 0.765 and 0.772，respectively. Using the Bootstrap method with 1，000 resamples，the results showed a C-index of 0.776[95%CI（0.737~0.818）]. Conclusion The risk prediction model established in this study has good discriminatory ability and calibration，and can assist ICU medical staff in quickly identifying the risk of microaspiration in mechanically ventilated patients.

Key words: Intensive Care Unit, Intubation，Intratracheal, Oropharyngeal Secretions, Microaspiration, Prediction Model, Critical Care Nursing

邓伟, 王英, 谭丽萍, 朱建军, 徐苏娟, 唐雯, 邹洁, 刘励军. ICU经口气管插管患者口咽分泌物微误吸风险预测模型的构建及初步验证[J]. 中华护理杂志, 2025, 60(21): 2620-2626.

DENG Wei, WANG Ying, TAN Liping, ZHU Jianjun, XU Sujuan, TANG Wen, ZOU Jie, LIU Lijun. Construction and validation of a risk prediction model for microaspiration of oropharyngeal secretions in ICU patients with endotracheal intubation[J]. Chinese Journal of Nursing, 2025, 60(21): 2620-2626.

图/表 4

表1 ICU气管插管患者一般资料及口咽分泌物微误吸发生情况的单因素分析[例（百分比，%）]

Table 1 Univariate analysis of general characteristics and microaspiration of oropharyngeal secretions in ICU patients with endotracheal intubation [cases（percentage，%）]

表2 ICU气管插管患者口咽分泌物微误吸发生影响因素的Logistic回归分析（n=476）

Table 2 Logistic regression analysis result of influential factors for microaspiration of oropharyngeal secretions in ICU patients with endotracheal intubation（n=476）

图1 ICU经口气管插管患者口咽分泌物微误吸发生风险预测模型列线图

Figure 1 Nomogram prediction model of microaspiration of oropharyngeal secretions in ICU patients with endotracheal intubation

图2 预测模型的决策分析曲线

Figure 2 The decision curve of the model

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