摘要
目的通过构建重症脑卒中患者早期肠内营养后预后不良的Nomogram模型,评价腹内压和具核梭杆菌丰度对重症脑卒中患者早期肠内营养(EN)预后不良的预测作用。方法选取浙江省温州市中心医院2022年7月~2023年7月收治的重症脑卒中并行首次早期肠内营养治疗的118例作为研究对象,随访2个月根据MRS量表将118例分为预后良好组(62例)和预后不良组(56例)。采用单因素分析和多因素Logistic回归分析确定影响重症脑卒中患者早期肠内营养预后的因素。运用R软件绘制Nomogram模型确定腹内压和具核梭杆菌丰度与重症脑卒中患者早期EN预后不良的关系;利用ROC曲线评估腹内压与F.N丰度在预测重症脑卒中患者接受早期EN治疗后预后不良方面的价值。结果年龄、NIHSS评分、腹内压及F.N丰度是重症脑卒中患者在接受早期EN治疗后预后不良的危险因素;预测重症脑卒中患者接受早期EN预后不良的Nomogram模型具有良好的区分度(AUC=0.958)和一致性(Hosmer-Lemeshow检验的P=0.979)。ROC曲线显示,腹内压与F.N丰度可以作为重症脑卒中早期EN患者预后不良的预测指标且联合预测的效果更显著。结论腹内压与F.N丰度可以作为重症脑卒中早期EN患者预后不良的预测指标且联合预测的效果更好。
Objective To construct a Nomogram model for poor prognosis after early enteral nutrition(EN)in severe stroke patients,and evaluate the predictive value of intra-abdominal pressure and Fusobacterium nucleatum(F.n)abundance for poor prognosis of early EN in such patients.Method A total of 118 severe stroke patients admitted to Wenzhou Central Hospital of Zhejiang Province from July 2022 to July 2023 and receiving initial early enteral nutrition therapy were selected as subjects.After 2 months of follow-up,all patients were divided into a good prognosis group(62 cases)and a poor prognosis group(56 cases)according to the Modified Rankin Scale(MRS).Univariate analysis and multivariate Logistic regression analysis were used to identify factors influencing the prognosis of early enteral nutrition in severe stroke patients.R software was applied to plot the Nomogram model to determine the relationship between intra-abdominal pressure,F.n abundance and poor prognosis of early EN in severe stroke patients;ROC curves were used to assess the value of intra-abdominal pressure and F.n abundance in predicting poor prognosis in severe stroke patients after early EN treatment.Result Age,NIHSS score,intra-abdominal pressure and F.n abundance were risk factors for poor prognosis in severe stroke patients after early EN treatment.The Nomogram model for predicting poor prognosis of early EN in severe stroke patients showed good discrimination(AUC=0.958)and consistency(P=0.979 in Hosmer-Lemeshow test).ROC curves indicated that intra-abdominal pressure and F.n abundance could serve as predictive indicators for poor prognosis in severe stroke patients with early EN,and the combined predictive effect was more significant.Conclusion Intra-abdominal pressure and F.n abundance can be used as predictive indicators for poor prognosis in severe stroke patients receiving early EN,with a better combined predictive efficacy.
作者
董绍熙
章雪娜
郑开慧
DONG Shaoxi;ZHANG Xuena;ZHENG Kaihui(Wenzhou Central Hospital,Wenzhou 325000,China)
出处
《浙江实用医学》
2025年第5期393-398,共6页
Zhejiang Practical Medicine
关键词
重症脑卒中
肠内营养
预后
腹内压
具核梭杆菌
F.N丰度
severe stroke
enteral nutrition
prognosis
intra-abdominal pressure
Fusobacterium nucleatum
F.N abundance
