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:

目的 分析慢性阻塞性肺疾病（COPD）重症机械通气患者并发急性胃肠损伤的影响因素并构建预测模型。方法 选取2019年6月—2024年6月在崇州市人民医院接受机械通气治疗的91例COPD重症患者为研究对象，根据是否发生急性胃肠损伤分为并发组22例（出现急性胃肠损伤）与非并发组69例（未出现急性胃肠损伤），对两组患者的临床资料进行单因素分析，并将差异有统计学意义的因素纳入多因素逐步Logistic回归模型，基于影响因素构建预测模型并评估该模型的预测效能。结果 并发组的插管时间长于非并发组（P <0.05），APACHEⅡ评分高于非并发组（P <0.05），肺氧合指数低于非并发组（P <0.05），呼吸机相关肺炎和病变累及多肺叶的占比均高于非并发组（P <0.05）。多因素逐步Logistic回归分析结果显示，插管时间长［O^R =0.096（95% CI：0.014，0.637）］、有呼吸机相关肺炎［O^R =8.226（95% CI：1.980，34.180）］、病变累及多肺叶［O^R =9.411（95% CI：1.961，45.163）］、高APACHEⅡ评分［O^R =3.267（95% CI：1.171，9.113）］、低肺氧合指数（P/F）［O^R =0.053（95% CI：0.008，0.344）］均是COPD重症机械通气并发急性胃肠损伤的危险因素（P <0.05）。根据自变量的偏回归系数建立预测模型，并构建列线图。该模型的曲线下面积为0.980，敏感性为95.5%（95% CI：0.772，0.999），特异性为95.7%（95% CI：0.878，0.991），模型具有良好的拟合校准曲线。结论 插管时间长、有呼吸机相关肺炎、病变累及多肺叶、高APACHEⅡ评分及低P/F是COPD重症机械通气并发急性胃肠损伤的独立危险因素，基于上述影响因素构建的预测模型可以准确预测COPD重症机械通气并发急性胃肠损伤的风险。

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?/FiO? 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 [O^R = 0.096 (95% CI: 0.014, 0.637) ], VAP [O^R = 8.226 (95% CI: 1.980, 34.180) ], multilobar involvement [O^R = 9.411 (95% CI: 1.961, 45.163) ], elevated APACHE Ⅱ score [O^R = 3.267 (95% CI: 1.171, 9.113) ], and reduced PaO? / FiO? ratio [O^R = 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.