重症患者喂养不耐受预测因子指标体系的构建及适用性分析

doi:10.3761/j.issn.2096-7446.2026.04.001

中华急危重症护理杂志 ›› 2026, Vol. 7 ›› Issue (4): 389-395.doi: 10.3761/j.issn.2096-7446.2026.04.001

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重症患者喂养不耐受预测因子指标体系的构建及适用性分析

赵明曦¹(), 罗红波¹, 徐园², 兰元梅³, 万朝阳¹, 裘博峯¹, 李尊柱¹, 井杰¹, 常晓未¹, 吴欣娟³^,^*()

¹ 中国医学科学院北京协和医学院北京协和医院重症医学科北京市 100730
² 中国医学科学院北京协和医学院北京协和医院保健医疗部北京市 100730
³ 中国医学科学院北京协和医学院北京协和医院护理部北京市 100730

收稿日期:2025-11-10 出版日期:2026-04-10 发布日期:2026-04-02
通讯作者: 吴欣娟 E-mail:13261788938@163.com;wuxinjuan@sina.com
作者简介:赵明曦：男，本科（硕士在读），主管护师，E-mail：13261788938@163.com
基金资助:
北京协和医院护理科研项目(XHHLKY202305)

Construction of a predictive indicator system for feeding intolerance in critically ill patients

ZHAO Mingxi¹(), LUO Hongbo¹, XU Yuan², LAN Yuanmei³, WAN Zhaoyang¹, QIU Bofeng¹, LI Zunzhu¹, JING Jie¹, CHANG Xiaowei¹, WU Xinjuan³^,^*()

¹ Department of Critical Care Medicine， Peking Union Medical College Hospital，Chinese Academy of Medical Sciences & Peking Union Medical College， Beijing 100730， China
² Department of Health Care， Peking Union Medical College Hospital，Chinese Academy of Medical Sciences & Peking Union Medical College， Beijing 100730， China
³ Department of Nursing， Peking Union Medical College Hospital，Chinese Academy of Medical Sciences & Peking Union Medical College， Beijing 100730， China

Received:2025-11-10 Online:2026-04-10 Published:2026-04-02
Contact: WU Xinjuan E-mail:13261788938@163.com;wuxinjuan@sina.com
Supported by:
Nursing Research Project of Peking Union Medical College Hospital(XHHLKY202305)

摘要/Abstract

摘要：

目的构建科学、系统、具有临床适用性的重症患者喂养不耐受预测因子指标体系，为早期识别高风险患者及开发预测模型提供依据。方法通过系统评价整合现有预测因子证据，结合两轮德尔菲专家函询筛选指标。纳入27篇文献进行Meta分析，邀请17名重症医学、护理、营养等领域专家，采用Likert 5级评分法评估指标重要性，依据均数、变异系数和满分率进行筛选。结果构建了包含6个一级指标、29个二级指标的预测因子体系，涵盖个体特征、疾病严重程度、生化指标、治疗因素、营养支持策略和胃肠功能因素。专家权威系数分别为0.920和0.923，肯德尔和谐系数具有统计学意义（P<0.05）。关键指标包括急性生理与慢性健康评价Ⅱ评分、序贯器官衰竭评估评分、机械通气、腹内压、胃窦运动指数等，均获得高度共识。结论该研究系统整合了循证证据与专家共识，构建了具有较高临床适用性的喂养不耐受预测因子体系，为重症患者营养支持的精准化管理提供了科学基础。未来应进一步开展模型开发与临床验证，推动其向实用工具转化。

关键词: 重症患者, 喂养不耐受, 预测因子, 指标体系, 德尔菲法, 系统评价

Abstract:

Objective To construct a scientific，systematic，and clinically applicable predictive indicator system for feeding intolerance in critically ill patients，providing a basis for early identification of high-risk patients and the development of predictive models. Methods Evidence on existing predictive factors was integrated through a systematic review，and indicators were screened via two rounds of Delphi expert consultation. A meta-analysis of 27 studies was conducted，and 17 experts in critical care medicine，nursing，and nutrition were invited to rate the importance of indicators using the Likert 5-point scale. Indicators were selected based on mean score，coefficient of variation，and full-score rate. Results A predictive indicator system comprising 6 first-level indicators and 29 second-level indicators was established，covering individual characteristics，disease severity，biochemical indicators，treatment factors，nutritional support strategies，and gastrointestinal function factors. The expert authority coefficients were 0.920 and 0.923，and the coordination coefficients were statistically significant（P<0.05）. Key indicators，including APACHE Ⅱ score，SOFA score，mechanical ventilation，intra-abdominal pressure，and antral motility index，achieved high consensus. Conclusion This study systematically integrated evidence-based findings and expert consensus to develop a clinically applicable predictive indicator system for feeding intolerance in critically ill patients，providing a scientific foundation for precise nutritional management. Future research should focus on model development and clinical validation to translate the system into practical tools.

Key words: Critically Ill Patients, Feeding Intolerance, Predictive Factors, Indicator System, Delphi Method, Systematic Review

赵明曦, 罗红波, 徐园, 兰元梅, 万朝阳, 裘博峯, 李尊柱, 井杰, 常晓未, 吴欣娟. 重症患者喂养不耐受预测因子指标体系的构建及适用性分析[J]. 中华急危重症护理杂志, 2026, 7(4): 389-395.

ZHAO Mingxi, LUO Hongbo, XU Yuan, LAN Yuanmei, WAN Zhaoyang, QIU Bofeng, LI Zunzhu, JING Jie, CHANG Xiaowei, WU Xinjuan. Construction of a predictive indicator system for feeding intolerance in critically ill patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(4): 389-395.

图/表 3

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重症患者喂养不耐受预测因子指标体系的构建及适用性分析

Construction of a predictive indicator system for feeding intolerance in critically ill patients

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