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目的:研究呼吸重症监护病房(RICU)有创机械通气病人早期营养治疗及其他因素对28 d病死率的影响。方法:将呼吸衰竭行气管插管的64例病人分为存活组和病死组。记录血清清蛋白(ALB)水平、APACHEⅡ评分和并发症情况,营养支持方式(包括完全肠内营养和混合营养),分析影响28 d病死率的因素。结果:混合效应模型分析显示,入住RICU时间是个显著的预测变量(P<0.05),分组不是显著的预测变量(P>0.05)。而入住RICU时间和分组的交互效应是个显著的预测变量(P<0.05)。包含五个变量:第1天实际热量/标准热量、第2天实际热量/标准热量、1周后清蛋白、呼吸机相关性肺炎(VAP)、肾功能衰竭的判别分析显示Wilks’s Lambda是显著的(P<0.05),表明该模型能预测第28天病人是否死亡。结论:1早期(48 h内)摄入热量与28 d病死率有关。2五个变量的模型对第28天病死率正确的预测为83.3%,对存活正确的预测为72.7%。
Objective: To study the effects of early nutritional therapy and other factors on 28-day mortality in patients with respiratory mechanical care unit (RICU) with invasive mechanical ventilation. METHODS: Sixty-four patients with endotracheal intubation for respiratory failure were divided into survivors and those who died. Serum albumin (ALB) levels, APACHE II scores and complications, nutritional support (including total enteral nutrition and mixed nutrition) were recorded and the factors influencing 28-day mortality were analyzed. Results: The mixed effect model analysis showed that the RICU admission time was a significant predictor (P <0.05), and the grouping was not a significant predictor (P> 0.05). The interaction effect between RICU time and grouping was a significant predictor (P <0.05). Five variables were included: discriminant analysis of Day 1 actual calorie / calorie, Day 2 actual calorie / calorie, Cleavage 1 week later, ventilator-associated pneumonia (VAP), and renal failure showed Wilks’s Lambda was significant (P <0.05), indicating that the model can predict whether the patient died on the 28th day. Conclusion: 1 Early (48 h) intake of calories and 28 d mortality. 2 The five-variable model correctly predicted mortality at 28 days to be 83.3% and correctly predicted survival to 72.7%.