老年ICU患者可能肌少症性吞咽障碍的相关因素及临床分类模型的构建：一项横断面研究

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中文摘要

目的： 分析老年ICU患者可能肌少症性吞咽障碍的相关因素，构建临床分类模型，为早期床旁识别和针对性干预提供依据。
方法： 采用便利抽样法，于2025年1月至12月纳入某三级医院ICU收治的160例老年患者，进行横断面研究。采用Ishii肌少症筛查评分和改良饮水试验（MWST）对患者进行分组。收集的数据包括患者一般特征、吞咽相关肌肉超声测量、胃动力超声参数、功能状态指标及营养风险筛查结果。应用单因素分析和二元logistic回归识别与结局相关的因素。构建分类模型，并使用R软件以列线图形式可视化。
结果： 老年ICU患者可能肌少症性吞咽障碍的患病率为65.62%。多变量logistic回归显示，NRS 2002评分≥3、颏舌肌严重变薄、存在合并症、发声异常及自主咳嗽能力评分≤2与可能肌少症性吞咽障碍的更高几率独立相关。表观受试者工作特征曲线下面积（AUC）为0.837（95% CI：0.775-0.900），bootstrap内部验证后偏倚校正AUC为0.812。
结论： 可能肌少症性吞咽障碍在老年ICU患者中高度流行，并与营养状态、吞咽肌形态、合并症负担、发声功能及气道保护能力相关。该分类模型显示出良好的区分度、校准度和临床实用性，可作为床旁风险分层工具。在临床实施前需要进行多中心外部验证。

英文摘要

OBJECTIVE: To analyze factors associated with probable sarcopenic dysphagia in older ICU patients, develop a clinical classification model, and provide evidence for early bedside identification and targeted intervention.
METHODS: A cross-sectional study was conducted with 160 older patients admitted to a tertiary ICU from January to December 2025 via convenience sampling. Patients were grouped using the Ishii sarcopenia screening score and the Modified Water Swallowing Test (MWST). Data collected included general patient characteristics, ultrasound measurements of swallowing-related muscles, gastric motility ultrasound parameters, functional status indicators, and nutritional risk screening results. Univariate analysis and binary logistic regression were applied to identify factors associated with the outcome. A classification model was constructed and visualized as a nomogram using R software.
RESULTS: The prevalence of probable sarcopenic dysphagia among older ICU patients was 65.62%. Multivariable logistic regression showed that NRS 2002 score ≥ 3, severe genioglossus muscle thinning, presence of comorbidities, abnormal vocalization, and voluntary cough ability score ≤ 2 were independently associated with higher odds of probable sarcopenic dysphagia. The apparent area under the receiver operating characteristic curve (AUC) was 0.837 (95% CI: 0.775-0.900), and the bias-corrected AUC after bootstrap internal validation was 0.812.
CONCLUSION: Probable sarcopenic dysphagia is highly prevalent in older ICU patients and is associated with nutritional status, swallowing muscle morphology, comorbidity burden, vocal function, and airway protective capacity. The classification model demonstrates good discrimination, calibration, and clinical utility, and may serve as a bedside tool for risk stratification. Multicenter external validation is required before clinical implementation.