广西医学

目的探讨成人ICU住院患者发生显性误吸的危险因素，并构建列线图预测模型。方法选取1 173例ICU住院患者，按照7∶3的比例随机分配至建模组（n=821）和验证组（n=352）。根据是否存在显性误吸将建模组分为误吸组与非误吸组。采用多因素Logistic 回归模型分析成人ICU住院患者发生显性误吸的危险因素，并基于危险因素构建列线图预测模型，采用受试者工作特征曲线、校准曲线及决策曲线分析分别评价模型区分度、校准度及临床适用性。结果共有196例（16.71%）患者发生显性误吸。多因素Logistic 回归分析结果显示，机械通气、胃残余量、腹腔内压力、误吸史、呕吐是成人ICU住院患者发生显性误吸的独立危险因素（P<0.05）。采用列线图预测模型预测成人ICU住院患者发生显性误吸时，建模组与验证组的曲线下面积分别为0.851和0.920。校准曲线显示，预测概率与实际概率基本相符。决策曲线分析结果显示，内部和外部验证的阈值概率为0.201、0.164时，净获益较高。结论成人ICU住院患者显性误吸发生率较高，机械通气、胃残余量、腹腔内压力、误吸史、呕吐是成人ICU住院患者发生显性误吸的独立危险因素。基于上述因素构建的列线图预测模型有助于临床医护人员评估该人群发生显示误吸的风险。

Objective To investigate the risk factors for the occurrence of dominant aspiration in ICU adult inpatients, and to establish a nomogram prediction model. Methods A total of 1173 ICU inpatients were selected, and they were randomly assigned to modeling group (n=821) or validation group (n=352) in a ratio of 7:3. According to the presence of dominant aspiration, the modeling group was further assigned to aspiration group or non⁃aspiration group. The multivariate Logistic regression model was used to analyze the risk factors for the occurrence of dominant aspiration in ICU adult inpatients, and a nomogram prediction model was established based on the risk factors. The receiver operating characteristic curve, calibration curve, and decision curve analysis were employed to evaluate the discrimination, calibration, and clinical effectiveness, respectively. Results A total of 196 (16.71%) patients suffered from dominant aspiration. The results of multivariate Logistic regression analysis revealed that mechanical ventilation, gastric residual volume, intra⁃abdominal pressure, aspiration history, and vomiting were the independent risk factors for the occurrence of dominant aspiration in ICU adult inpatients (P<0.05). When employing the nomogram prediction model for predicting the occurrence of dominant aspiration in ICU adult inpatients, areas under the curve of the modeling group and the validation group were 0.851 and 0.920, respectively. The calibration curve revealed that the predictive probability was basically consistent with the actual probability. The results of decision curve analysis indicated that when probabilities of threshold of internal and external validations were 0.201 and 0.164, the net benefits were favorably high. Conclusion The incidence rate of dominant aspiration in ICU adult inpatients is favorably high. Mechanical ventilation, gastric residual volume, intra⁃abdominal pressure, aspiration history, and vomiting are the independent risk factors for the occurrence of dominant aspiration in ICU adult inpatients. The nomogram prediction model established based on the aforementioned factors is helpful for clinical medical and nursing personnel to evaluate the occurrence risk of dominant aspiration in this population.