Analysis of influencing factors and risk prediction model of latent aspiration in critically ill mechanically ventilated children
儿童重症机械通气患儿隐性误吸的影响因素分析与风险预测模型研究

摘要

目的 探讨儿童重症机械通气患者隐性误吸的影响因素，建立风险预测模型，为临床早期干预提供依据。方法 回顾性分析2022年1月—2024年12月广西某三甲儿童重症医学科（PICU）收治的216例机械通气患儿的临床资料，根据隐性误吸发生情况分为误吸组68例和非误吸组148例。采用单因素分析（卡方检验、t检验）筛选可能的影响因素，多因素Logistic回归分析确定独立影响因素，构建风险预测模型并通过ROC曲线评价其效能。结果 儿童重症机械通气患者隐性误吸发生率为31.48%。单因素分析显示，年龄<1岁、机械通气时间>7天、经鼻胃管喂养、使用镇静剂（>48h）、胃残留量>10ml/kg、合并神经系统疾病是隐性误吸的危险因素（P<0.05）。构建的风险预测模型ROC曲线下面积（AUC）为0.85，敏感度82.35%，特异度78.38%，提示模型预测效能良好。结论 基于年龄、胃残留量、机械通气方式、经鼻胃管喂养、镇静剂等5项指标构建的风险预测模型具有一定的临床价值，可作为医护人员识别机械通气隐性误吸高危患儿的工具。

Abstract

Objective To explore the influencing factors of hidden aspiration in children with severe mechanical ventilation, establish a risk prediction model, and provide a basis for early clinical intervention.
Methods A retrospective analysis was conducted on the clinical data of 216 mechanically ventilated children admitted to a tertiary pediatric intensive care unit (PICU) in Guangxi from January 2022 to December 2024. According to the occurrence of hidden aspiration, they were divided into a aspiration group of 68 cases and a non aspiration group of 148 cases. Single factor analysis (chi square test, t-test) was used to screen for possible influencing factors, and multiple factor logistic regression analysis was used to determine independent influencing factors. A risk prediction model was constructed and its effectiveness was evaluated through ROC curve.
Results The incidence of hidden aspiration in critically ill mechanically ventilated children was 31.48%. Univariate analysis showed that age<1 year, duration of mechanical ventilation>7 days, nasogastric tube feeding, use of sedatives (>48 hours), gastric residual dose>10ml/kg, and comorbidity with neurological disorders were risk factors for occult aspiration (P<0.05). The area under the ROC curve (AUC) of the constructed risk prediction model is 0.85, with a sensitivity of 82.35% and a specificity of 78.38%, indicating good predictive performance of the model.
Conclusion   The risk prediction model constructed based on five indicators including age, gastric residue, mechanical ventilation method, nasogastric tube feeding, and sedatives has certain clinical value and can be used as a tool for medical staff to identify high-risk children with hidden aspiration caused by mechanical ventilation.