重症监护病人的夜间肠道养和机械通风风险:基于深度学习的因果推断研究
Min Woo Kang1, Soojeong Yun1, Seung Min Song1
1Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea.
Clinical nutrition (Edinburgh, Scotland)
|January 10, 2026
概括
在重症监护室 (ICU) 的夜间肠道营养可能会增加对机械通风的需求,特别是在大量的情况下. 建议重新考虑一夜间养的做法,以减少呼吸道并发症.
科学领域:
- 关键护理医学 关键护理医学
- 营养支持 营养支持
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 持续的肠道营养是重症患者的标准,但其对间歇性养的好处尚不清楚.
- 夜间养是一种常见的做法,引起了人们对吸气风险的担忧,原因是睡眠期间呼吸道保护减少.
- 在重症监护室 (ICU) 患者的夜间肠道养和机械通风需求之间的关联尚未得到充分证实.
研究的目的:
- 调查夜间肠道养是否增加了ICU患者需要机械通风的可能性.
- 分析夜间肠道养对呼吸支需求的影响.
- 探索患者特征和影响这种关联的食量.
主要方法:
- 利用两个大型ICU数据库 (MIMIC-IV和eICU) 进行模型开发和外部验证.
- 分析了在ICU入院72小时内接受肠道食的患者,重点是夜间食 (下午10点至早上6点).
- 采用多变量回归,基于深度学习的因果推断和SHapley添加式扩展 (SHAP) 来评估结果 (在72小时后的机械通风) 并确定预测因素.
主要成果:
- 夜间肠道养与两个队列中需要机械通风的几率显著增加 (ORs从1.88到2.45不等).
- 因果推理模型估计,夜间食增加了机械通风的概率3.50%至7.29%.
- 总每日肠道养量成为通风风险的最关键预测指标;没有脑血管疾病的患者在夜间养时风险增加.
结论:
- 在非输管ICU患者的夜间肠道养可能会增加机械通风的风险,特别是在高养量的情况下.
- 研究结果表明,需要重新评估当前的夜间连续养方案.
- 关于昼夜调整营养的前性研究是有必要的,以减轻呼吸道并发症.
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