PICU气管插管患儿拔管后吞咽障碍的危险因素分析与预测模型的建立

    Study on the risk factors of post-extubation dysphagia in children with endotracheal intubation in PICU and constructon of prediction model

    • 摘要: 目的: 探讨儿童重症监护室(PICU)气管插管患儿拔管后吞咽障碍(PED)的危险因素,构建风险预测模型,为早期识别和预防PICU气管插管患儿拔管后吞咽障碍提供参考依据。方法: 回顾性选取2020年10月至2023年10月收治在安徽省儿童医院PICU的84例机械通气患儿为研究对象,根据患儿是否发生PED,将其分为吞咽障碍组和非吞咽障碍组,采用logistic回归分析PICU患儿拔管后吞咽障碍的危险因素,对筛选出的危险因素根据回归系数构建预测模型,并通过 Hosmer-Lemeshow (H-L)检验及绘制受试者工作特征(ROC)曲线对模型进行拟合优度及预测效果检验评价。结果: 吞咽障碍组40例,非吞咽障碍组44例,吞咽障碍发生率为47.62%。二元 logistic 回归分析结果显示,年龄≤3岁、神经系统受损、咪达唑仑(泵入)、气管插管留置时间≥72 h、胃管留置时间≥72 h、医源性戒断综合征是PICU气管插管患儿拔管后PED的独立危险因素。ROC曲线结果显示,曲线下面积为0.791,95%CI为0.688~0.894,显示模型预测效能良好。H-L检验P=0.10,表明模型拟合优度良好。结论: 年龄、咪达唑仑、神经系统受损、气管插管留置时间、胃管留置时间以及医源性戒断综合征是气管插管患儿PED发生的危险因素,基于以上因素构建的风险预测模型可直观地评价PICU气管插管患儿PED发生的风险,具有一定的临床应用价值。

       

      Abstract: Objective: To investigate the risk factors of post-extubation dysphagia (PED) in children with endotracheal intubation in the pediatric intensive care unit(PICU) and to construct a risk prediction model,so as to provide a reference for early identification and prevention of post-extubation dysphagia in children with endotracheal intubation in PICU. Methods: A total of 84 children with mechanical ventilation admitted to the PICU of Anhui Provincial Children's Hospital from October 2020 to October 2023 were retrospectively selected as the research subjects.According to the presence or absence of PED,the children were divided into the dysphagia group and non-dysphagia group.Logistic regression was used to analyze the risk factors of dysphagia in children in PICU after extubation.The selected risk factors were used to construct a prediction model according to the regression coefficient,and the Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve were used to test and evaluate the goodness of fit and prediction effects of the model. Results: There were 40 patients in the dysphagia group and 44 patients in the non-dysphagia group,and the incidence of dysphagia was 47.62%.The results of binary logistic regression analysis showed that age ≤3 years,nervous system damage,midazolam(pumped),indwelling time of endotracheal intubation ≥72 h,indwelling time of gastric tube ≥72 h and iatrogenic withdrawal syndrome were the independent risk factors of PED after extubation in children with endotracheal intubation in PICU.The ROC curve results showed that the AUC was 0.791,95%CI:0.688-0.894,which indicated that the model had good prediction efficiency.Hosmer-Lemeshow test showed P=0.10,which indicated that the model had a good goodness of fit. Conclusions: The age,midazolam,neurological impairment,indwelling time of endotracheal intubation,indwelling time of gastric tube,and iatrogenic withdrawal syndrome are the risk factors of PED in children with endotracheal intubation.The risk prediction model based on the above factors can visually evaluate the risk of PED in children with endotracheal intubation in PICU,and has certain clinical application value.

       

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