中国现代医学杂志2025，Vol.35Issue(5)：90-96,7.DOI:10.3969/j.issn.1005-8982.2025.05.015
慢性阻塞性肺疾病重症机械通气并发急性胃肠损伤的影响因素及预测模型
Risk factors and prediction model for acute gastrointestinal injury in severe chronic obstructive pulmonary disease patients undergoing mechanical ventilation
摘要
Abstract
Objective To analyze risk factors and construct a prediction model for acute gastrointestinal injury(AGI)in severe chronic obstructive pulmonary disease(COPD)patients requiring mechanical ventilation.Methods A total of 91 severe COPD patients receiving mechanical ventilation at Chongzhou People's Hospital from June 2019 to June 2024 were enrolled.Participants were stratified into two groups:AGI group(n=22)and non-AGI group(n=69).Clinical variables were compared using univariate analysis,and statistically significant factors were incorporated into a multivariate stepwise Logistic regression model.A nomogram prediction model was developed and its efficacy validated.Results The AGI group exhibited significantly prolonged intubation duration(P＜0.05),higher APACHE Ⅱ scores(P＜0.05),lower PaO 2/FiO 2 ratios(P＜0.05),and increased incidence of ventilator-associated pneumonia(VAP)and multilobar lung involvement compared to the non-AGI group(both P＜0.05).Multivariate analysis identified independent risk factors:prolonged intubation[OR=0.096(95％CI:0.014,0.637)],VAP[(OR)=8.226(95％CI:1.980,34.180)],multilobar involvement[R(OR)=9.411(95％CI:1.961,45.163)],elevated APACHE Ⅱ score[(OR)=3.267(95％CI:1.171,9.113)],and reduced PaO2/FiO2 ratio[(OR)=0.053(95％CI:0.008,0.344)](all P＜0.05).The nomogram demonstrated excellent discrimination(AUC=0.980)with sensitivity of 95.5％(95％CI:0.772,0.999)and specificity of 95.7％(95％CI:0.878,0.991),coupled with favorable calibration.Conclusion Prolonged intubation,VAP,multilobar lung involvement,high APACHE Ⅱ scores,and impaired oxygenation are independent predictors of AGI in mechanically ventilated COPD patients.The validated nomogram provides a clinically actionable tool for early risk stratification.关键词
慢性阻塞性肺疾病/重症/机械通气/急性胃肠损伤/预测模型Key words
chronic obstructive pulmonary disease/critical illness/mechanical ventilation/acute gastrointestinal injury/prediction model分类
临床医学引用本文复制引用
李晓临,戴忠红,陈聂..慢性阻塞性肺疾病重症机械通气并发急性胃肠损伤的影响因素及预测模型[J].中国现代医学杂志,2025,35(5):90-96,7.基金项目
四川省科技计划研发项目(No:2022YFS0262) （No:2022YFS0262）
