2025 年第 12 期 第 20 卷

老年重症肺炎患者早期肠内营养不耐受的危险因素及列线图模型的构建

The risk factors of early enteral nutrition intolerance in elderly patients with severe pneumonia and construction of nomogram model

作者：彭思芹俞荷花陈红李菲菲

英文作者：Peng Siqin Yu Hehua Chen Hong Li Feifei

单位：中国人民解放军海军军医大学第二附属医院急诊重症医学科，上海200000

英文单位：Department of Emergency and Critical Care Medicine The Second Affiliated Hospital of Naval Medical University of the Chinese People′s Liberation Army Shanghai 200000 China

关键词：重症肺炎；早期肠内营养；不耐受；影响因素

英文关键词：Severepneumonia;Earlyenteralnutrition;Intolerance;Influencingfactors

• 摘要：

• 目的 探讨老年重症肺炎患者早期肠内营养（EEN）不耐受的危险因素，构建列线图模型，并进行验证。方法 选取2023年1月至2025年1月中国人民解放军海军军医大学第二附属医院老年重症肺炎患者209例，统计患者EEN耐受情况，根据是否出现EEN不耐受症状分为耐受组、不耐受组。分析EEN不耐受的危险因素，绘制列线图，采用受试者工作特征曲线检验列线图模型的预测效能。结果 209例老年重症肺炎患者中有86例出现EEN不耐受，发生率为41.1%（86/209）。EEN不耐受患者中74.4%（64/86）为单一症状，以腹泻、胃潴留、腹胀为主，25.6%（22/86）出现两种及以上症状，EEN不耐受主要发生在EEN开始实施的第1天和第2天。年龄大、开始肠内营养时间晚、临床肺部感染评分（CPIS）高、机械通气时间长、间断注入均为老年重症肺炎患者EEN不耐受的独立危险因素（均P＜0.05）。根据Logistic回归分析结果筛选出的影响因素构建老年重症肺炎患者EEN不耐受的预测模型，logit（P）=-15.541+0.923×年龄+0.966×开始肠内营养时间+0.854×CPIS+0.338×机械通气时间-0.959×喂养方式，经Hosmer-Lemeshow拟合优度检验显示，χ2=4.138，自由度=8，P=0.830。列线图显示各项影响因素评分之和＞144分时，EEN不耐受风险超过80%。列线图模型的一致性指数为0.888，预测老年重症肺炎患者EEN不耐受的曲线下面积为0.888（95%置信区间：0.837～0.927）。结论 老年重症肺炎患者EEN不耐受的危险因素包括年龄高、开始肠内营养时间晚、CPIS高、机械通气时间长、间断注入，基于以上影响因素构建的列线图模型对老年重症肺炎患者EEN不耐受具有较高的预测效能，有助于医护人员准确识别高危人群，对营养管理策略的改进具有指导意义。

• Objective To explore the risk factors of early enteral nutrition (EEN) intolerance in elderly patients with severe pneumonia, and to construct and verify a nomogram model. Methods A total of 209 elderly patients with severe pneumonia in The Second Affiliated Hospital of Naval Medical University of Chinese People′s Liberation Army from January 2023 to January 2025 were selected. EEN tolerance of patients was recorded. According to the presence or absence of EEN intolerance symptoms, the patients were divided into tolerance group and intolerance group. The risk factors of EEN intolerance were analyzed and a nomogram was drawn. The receiver operating characteristic curve was used to test the predictive efficacy of the nomogram model. Results Among 209 elderly patients with severe pneumonia, 86 cases had EEN intolerance. The incidence was 41.1%(86/209). Among the patients with EEN intolerance, 74.4%(64/86) had single symptom, mainly diarrhea, gastric retention and abdominal distension, 25.6%(22/86) had two or more symptoms, and EEN intolerance mainly occurred on the first and second day of the implementation of EEN. Old age, late start of enteral nutrition, high clinical pulmonary infection score (CPIS), long duration of mechanical ventilation and intermittent injection were independent risk factors for EEN intolerance in elderly patients with severe pneumonia (all P＜0.05). The prediction model of EEN intolerance in elderly patients with severe pneumonia was constructed according to the influencing factors screened from the results of Logistic regression analysis. Logit(P)=-15.541+0.923×age +0.966×initiation time of enteral nutrition +0.854×CPIS +0.338×mechanical ventilation time -0.959×feeding mode. Hosmer-Lemeshow goodness of fit test showed that χ2=4.138, degree of freedom=8, P=0.830. The nomogram showed that when the sum of the scores of each influencing factor was more than 144, the risk of EEN intolerance was more than 80%. The consistency index of the nomogram model was 0.888, and the area under the curve for predicting EEN intolerance in elderly patients with severe pneumonia was 0.888 (95% confidence interval: 0.837-0.927). Conclusion The risk factors of EEN intolerance in elderly patients with severe pneumonia include old age, late start time of enteral nutrition, high CPIS, long duration of mechanical ventilation and intermittent injection. The nomogram model based on the above influencing factors has a high predictive efficiency for EEN intolerance in elderly patients with severe pneumonia, which is helpful for medical staff to accurately identify high-risk groups. It has guiding significance for the improvement of nutrition management strategy.