神经外科老年昏迷患者鼻饲反流误吸调查及其危险因素分析

Investigation of nasal feeding reflux aspiration in elderly coma patients in neurosurgery department and analysis of its risk factors

中文关键词: 老年  昏迷  神经外科  鼻饲反流误吸  危险因素  模型

英文关键词: coma  neurosurgery department  nasal feeding reflux aspiration  risk factor  model

中文摘要:

      目的 调查神经外科老年昏迷患者鼻饲反流误吸现状,并分析其危险因素,为临床制定预防干预措施提供参考.方法 回顾性选取2020 年8 月—2022 年7 月于空军军医大学第二附属医院神经外科收治的320 例老年昏迷患者作为研究对象,统计患者鼻饲反流误吸现状,并根据患者是否发生鼻饲反流误吸分为误吸组(n =79)和非误吸组(n =241),比较2 组临床资料,采用二元多因素Logistic回归分析鼻饲反流误吸的危险因素,并构建风险预测模型.结果 本研究共纳入320 例神经外科老年昏迷患者,79 例发生鼻饲反流误吸,发生率为24.69%;误吸组和非误吸组年龄构成、鼻饲置管长度、误吸史、胃残留量、APACHE Ⅱ评分、GCS评分、营养不良差异均具有统计学意义(P＜0.05);二元多因素Logistic分析结果显示,年龄≥75 岁(OR =3.265,P＜0.001)、误吸史(OR =2.596,P =0.002)、胃残留量≥150 mL(OR =2.594,P = 0.003)、GCS评分＜8 分(OR =3.625,P =0.002)、营养不良(OR =3.181,P =0.001)均为影响神经外科老年昏迷患者鼻饲反流误吸的独立危险因素(P＜0.05);Hosmer-Lemeshow检验显示,预测模型的 AUC 为 0.809(95%CI:0.757～0.861),表明该模型有较好的拟合度和预测效能(χ2 =3.233,P =0.919,P＜0.05).结论 年龄≥75 岁、误吸史、胃残留量≥150 mL、GCS评分＜8 分、营养不良均可能为神经外科老年昏迷患者鼻饲反流误吸的高危因素,临床可据此及早进行干预,以防治鼻饲反流误吸.

英文摘要:

      Objective To investigate the current status of nasal feeding reflux aspiration in elderly coma patients in neu-rosurgery department and analyze its risk factors,so as to provide reference for clinical prevention and intervention measures.Methods A total of 320 elderly coma patients admitted to Department of Neurosurgery,Second Affiliated Hospital of Air Force Medical University from August 2020 to July 2022 were retrospectively selected as the study subjects.Their current status of nasal feeding reflux aspiration was statistically analyzed.They were divided into aspiration group(n =79)and non-aspira-tion group(n =241)according to whether they had nasal feeding reflux aspiration.The clinical data of the two groups were compared.Binary multivariate Logistic regression was used to analyze the risk factors of nasal feeding reflux aspiration,and a risk prediction model was constructed.Results A total of 320 elderly coma patients were included.Among them,79 ones ex-perienced nasal feeding reflux aspiration,with an incidence rate of 24.69%.There were significant differences in age composi-tion,length of nasal feeding tube,aspiration history,gastric residue volume,APACHEⅡscore,GCS score and malnutrition between the two groups(P＜0.05).The results of binary multivariate Logistic analysis showed that age≥75 years(OR = 3.265,P＜0.001),aspiration history(OR = 2.596,P = 0.002),gastric residue volume≥150 mL(OR = 2.594,P = 0.003),GCS score＜8 points(OR =3.625,P =0.002)and malnutrition(OR =3.181,P =0.001)were independent risk factors for nasal feeding reflux aspiration in elderly coma patients(P＜0.05).The Hosmer Lemeshow test showed that the AUC of the predictive model was0.809(95%CI:0.757-0.861),indicating that the model had good fitting and predictive performance(χ2 =3.233,P =0.919).Conclusion Age≥75 years,aspiration history,gastric residue volume≥150 mL,GCS score＜8 points and malnutrition may be the high-risk factors for nasal feeding reflux aspiration in elderly coma patients in neurosurgery department.Therefore,early clinical intervention should be taken based on these factors to prevent and treat nasal feeding reflux aspiration.