Abstract:

Objective To identify the latent trajectories of intra-abdominal pressure（IAP） in neurosurgery critically ill patients receiving enteral nutrition and to analyze their influencing factors，aiming to provide a reference for the early identification of populations at high risk for intra-abdominal hypertension. Methods A total of 137 patients admitted to the neurosurgical intensive care unit of a tertiary grade-A general hospital in Wuhan from January 2024 to June 2025 were enrolled. Clinical and socio-demographic data，along with daily IAP values from day 1 to day 7 of enteral nutrition，were collected. Growth mixture model（GMM） was utilized to identify distinct IAP trajectories，and multivariate logistic regression was performed to determine independent predictors. Results Ultimately，128 patients were included，with 9 patients dropping out. 3 heterogeneous trajectories were identified，inlcuding early hypertension with late remission type（13.28%），early normal-midterm high pressure-later alleviation type（17.19%），and persistent normalcy type（69.53%）. BMI，mechanical ventilation，sedative use，feeding route，abdominal distension，serum albumin，and mild hypothermia therapy were significantly associated with the trajectory of intra-abdominal pressure（P<0.05）. Conclusion IAP changes in neurosurgery patients under enteral nutrition exhibit significant inter-individual heterogeneity across 3 latent patterns. Medical staff should prioritize high-risk patients，specifically those with elevated BMI，mechanical ventilation，nasogastric feeding，sedative use，abdominal distension，and hypoproteinemia，to implement targeted IAP monitoring and individualized nutrition management.

Key words: Nervous System Diseases, Enteral Nutrition, Intraabdominal Pressure, Potential Category Analysis, Root Cause Analysis, Critical Care Nursing

摘要：

目的 探究神经外科肠内营养患者腹内压变化轨迹的潜在类别及其影响因素，为识别腹内高压高风险患者提供参考。方法 按入院顺序选取2024年1月—2025年6月在武汉市某三级甲等综合医院神经外科重症监护室住院且接受肠内营养支持的137例患者作为调查对象，收集其社会人口学及疾病相关资料，并在肠内营养第1~7天测量其腹内压。采用潜变量增长混合模型识别患者腹内压变化轨迹的潜在类别，使用Logistic回归分析探究其影响因素。结果 脱落9例患者，最终纳入128例，其腹内压变化轨迹分为3个潜在类别，包括早期高压-后期缓解型（13.28%）、早期正常-中期高压-后期缓解型（17.19%）和持续正常型（69.53%）。Logistic回归分析结果显示，BMI、是否进行机械通气、是否使用镇静药物、喂养途径、有无腹胀、血清白蛋白浓度以及是否接受亚低温治疗是神经外科肠内营养患者腹内压变化轨迹潜在类别的影响因素（均P<0.05）。结论 神经外科肠内营养患者腹内压变化轨迹存在3个潜在类别。医护人员应重点关注BMI较高、进行机械通气、经鼻胃管喂养、使用镇静药物、腹胀以及血清白蛋白浓度较低的患者，加强其腹内压监测，并制订个性化的营养管理方案。

关键词: 神经系统疾病, 肠内营养, 腹内压, 潜在类别分析, 影响因素分析, 危重病护理