关键词: 危重症, 急性胃肠损伤, 危险因素

Abstract: Objective To investigate the influencing  factors for early acute gastrointestinal injury in critically ill patients in the intensive care unit.Methods Among the patients admitted from January 2021 to July 2023,there were 80 critically ill patients with an APACHE Ⅱ score of ≥15 points.Based on whether gastrointestinal injury occurred within one week of admission,they were divided into an acute gastrointestinal injury group (observation group,40 cases) and a control group of 40 cases randomly selected from cases without gastrointestinal injury.Univariate analysis was conducted on various clinical data of the two groups of patients,and the meaningful indicators of univariate analysis were included as independent variables in logistic regression analysis to further screen for risk factors causing gastrointestinal injury in early severe patients.Receiver operating characteristic(ROC) curve was drawn to further evaluate the predictive value of risk factors.Results The results of univariate analysis showed that the observation group had neutrophil/lymphocyte ratio (NLR),lactate,albumin,and application time of vasoactive drugs (h) of 14.05±4.52,(6.94±1.66)mmol/L,(24.49±2.73)g/L,and 63 (0,93.5)h,respectively,while the control group had neutrophil/lymphocyte ratio (NLR),lactate,albumin,and vasoactive drug application time (h) of 8.78±3.74,(4.06±1.30)mmol/L,(26.89±2.90)g/L,and 0 (0,43)h,respectively.The differences between the two groups were statistically significant (P<0.05).The results of logistic regression analysis showed that NLR (OR=1.36,95%CI1.18-1.57,P<0.001),lactate (OR=18.54,95%CI 3.28-104.73,P=0.001),and application time of vasoactive drugs (h) (OR=1.03,95%CI 1.01-1.04,P<0.001) all had statistical significance and were risk factors for early acute gastrointestinal injury in critically ill patients;The variable albumin is a protective factor for early acute gastrointestinal injury in critically ill patients,but it has statistical significance (OR=0.74,95%CI 0.63-0.88,P=0.001).ROC curve analysis showed that NLR,lactate,and application time of vasoactive drugs(h) AUC (95%CI) were 0.800 (0.707-0.894),0.969 (0.940-0.999),and 0.716 (0.600-0.831),respectively;The sensitivities were 65%,85%,and 55%,respectively;and the specificities were 80%,95%,and 88%,respectively;the differences were statistically significant (P<0.05).Conclusion NLR,lactate,and application time of vasoactive drugs(h) are the risk factors for early acute gastrointestinal injury in critically ill patients in the intensive care unit,and have high predictive value.

Key words: critical illness, acute gastrointestinal injury, risk factors