肠系膜上动脉超声联合AGIUS对危重患者急性胃肠损伤及预后的评估价值OA
Predictive Value of Superior Mesenteric Artery Ultrasonography Combined with Acute Gastrointestinal Injury Ultrasound Score for Acute Gastrointestinal Injury and Prognosis in Critically Ill Patients
目的 探讨肠系膜上动脉收缩期峰值流速(SMA-PSV)联合急性胃肠损伤超声评分(AGIUS)对重症患者急性胃肠损伤(AGI)发生及28 d死亡的评估价值.方法 前瞻性选取 2025 年 5月至 10 月南京市第一医院重症医学科收治的重症患者125例,动态监测AGI分级与28 d死亡情况.根据是否发生AGI将患者分为AGI组(64例)和非AGI组(61例),同步行床旁超声测量SMA-PSV及AGIUS并构建联合评分系统.采用 Spearman 相关分析SMA-PSV联合AGIUS与AGI分级的相关性,采用多因素Logistic回归分析ICU患者AGI发生风险的影响因素,采用ROC曲线评估SMA-PSV联合AGIUS预测ICU患者AGI发生及28 d死亡的价值.结果 125 例患者中,AGI发生率 51.20%,28 d病死率20.00%.ROC曲线评估显示,SMA-PSV预测ICU患者AGI发生的曲线下面积为 0.736,AGIUS预测ICU患者AGI发生的曲线下面积为0.832,SMA-PSV联合AGIUS预测ICU患者AGI发生的曲线下面积为 0.892,SMA-PSV联合AGIUS预测ICU患者AGI发生的曲线下面积优于SMA-PSV、AGIUS 单独预测(P<0.001);多因素Logistic回归分析显示,SMA-PSV联合AGIUS为ICU患者AGI发生的独立影响因素(OR=5.291,95%CI:3.656～7.658,P<0.001).Spearman 相关分析显示,SMA-PSV联合AGIUS与AGI分级呈正相关,指标水平随 AGI 分级增高而升高(r=0.753,P<0.001).ROC曲线评估显示,SMA-PSV预测ICU患者28 d死亡的曲线下面积为0.787,AGIUS预测ICU患者28 d死亡的曲线下面积为0.811,SMA-PSV联合AGIUS预测ICU患者28 d死亡的曲线下面积为0.872,SMA-PSV联合AGIUS预测 ICU患者28 d死亡的曲线下面积高于SMA-PSV、AGIUS 单独预测(P<0.05),同时高于SOFA预测(P<0.001).结论 SMA-PSV联合AGIUS与AGI严重程度密切相关,能有效预测AGI的发生及重症患者的短期预后.
Objective To investigate the value of superior mesenteric artery peak systolic velocity(SMAPSV)combined with acute gastrointestinal injury ultrasound score(AGIUS)in predicting acute gastrointestinal injury(AGI)occurrence and 28-day prognosis in critically ill patients.Methods A total of 125 serious patients admitted to the Department of Critical Care Medicine,Nanjing First Hospital,from May to October 2025 were prospectively enrolled.The AGI grade and 28-day mortality were dynamically monitored.According to the occurrence of AGI,the patients were divided into the AGI group(n=64)and the nonAGI group(n=61).Meanwhile,bedside ultrasound was performed to measure SMAPSV and AGIUS,and a combined scoring system was further established.Spearman correlation analysis was used to analyze the correlation of SMAPSV combined with AGIUS with AGI grade.Multivariate logistic regression analysis was adopted to explore the influencing factors for the risk of AGI in ICU patients.ROC curve was used to evaluate the predictive value of SMAPSV combined with AGIUS for the occurrence of AGI and 28-day mortality in ICU patients.Results Of the 125 patients,the incidence of AGI was 51.20％,and the 28-day mortality rate was 20.00％.ROC curve analysis showed that the AUC of SMAPSV for predicting AGI in ICU patients was 0.736,while the AUC of AGIUS was 0.832.The combined prediction of SMAPSV and AGIUS yielded an AUC of 0.892,which was significantly higher than that of SMAPSV or AGIUS alone(P<0.001).Multivariate Logistic regression analysis demonstrated that the combined index of SMAPSV and AGIUS was an independent influencing factor for the occurrence of AGI in ICU patients(OR=5.291,95％CI:3.656-7.658,P<0.001).Spearman correlation analysis showed that the combination of SMA-PSV and AGIUS was positively correlated with AGI grade,and the index level increased with the elevation of AGI grade(r=0.753,P<0.001).ROC curve analysis also indicated that the AUC of SMAPSV for predicting 28-day mortality in ICU patients was 0.787,and the AUC of AGIUS was 0.811.The combined AUC of SMAPSV and AGIUS was 0.872,which was higher than the individual prediction of SMAPSV and AGIUS(P<0.05),and also higher than the prediction value of the Sequential Organ Failure Assessment score(P<0.001).Conclusion SMAPSV combined with AGIUS is closely correlated with the severity of AGI,and can effectively predict the occurrence of AGI and the shortterm prognosis of critically ill patients.
叶梓语;孙加奎;朱旋旋;尹翔;李邵;袁蛟龙;王璐;王翔
南京医科大学附属南京医院重症医学科,南京 210000南京医科大学附属南京医院重症医学科,南京 210000南京医科大学附属南京医院重症医学科,南京 210000南京医科大学附属南京医院重症医学科,南京 210000南京医科大学附属南京医院重症医学科,南京 210000南京医科大学附属南京医院重症医学科,南京 210000南京医科大学附属南京医院重症医学科,南京 210000南京医科大学附属南京医院重症医学科,南京 210000
急性胃肠损伤肠系膜上动脉床旁超声喂养不耐受预后
acute gastrointestinal injurysuperior mesenteric arterybedside ultrasoundfeeding intoleranceprognosis
《转化医学杂志》 2026 (8)
1313-1319,7
江苏省自然科学基金面上项目(BK20231128)
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