经皮氧分压监测对体外膜氧合治疗的重症急性呼吸衰竭患者预后的评估价值  

Effect of transcutaneous oximetry on prognosis of patients with severe acute respiratory failure receiving extracorporeal membrane oxygenation

作　　者：董亮[1] 张秀红[2] 梁锋鸣[1] 杨挺[1] 严洁[1] 严正[1] 李朗[3] 

机构地区：[1]南京医科大学附属无锡人民医院重症医学科,214023 [2]南京医科大学附属无锡人民医院药剂科,214023 [3]南京医科大学附属无锡人民医院教育处,214023

出　　处：《中华结核和呼吸杂志》2017年第9期683-688,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家自然科学基金（81400054）;江苏省自然科学基金（BK20140122）;江苏省青年医学重点人才项目（QNRC2017179）

摘　　要：目的 明确经皮氧分压监测对体外膜氧合（ECMO）治疗的重症急性呼吸衰竭患者预后的评估价值.方法 采用前瞻性研究,选取2013年1月至2015年12月南京医科大学附属无锡人民医院重症医学科（ICU）收治的49例因重症急性呼吸衰竭行静脉-静脉（V-V） ECMO治疗的患者.在ECMO治疗6h后行经皮氧分压监测和氧负荷试验,计算6h的10 min氧负荷值（OCT10）及氧负荷指数（OCI）,并收集患者的基本资料、血气分析、呼吸机参数及急性生理和慢性健康状况（APACHE）Ⅱ评分、序贯器官功能衰竭（SOFA）评分、Murray肺损伤评分等.依据ECMO治疗60 d后患者生存情况分为存活组和病死组,比较两组患者基本资料及临床指标,采用受试者工作特征（ROC）曲线评价OCT10、OCI对患者预后的预测价值,运用Kaplan-Meier法绘制患者的生存曲线,log-rank法分析患者生存情况,多因素logistic回归分析影响患者预后的相关因素.结果 存活组和病死组分别纳入25例及24例患者,两组基本情况差异无统计学意义（均P ＞0.05）;存活组OCT10和OCI分别为（77±11）mmHg（1 mmHg =0.133 kPa）和0.77±0.17,均高于病死组的（57±12） mmHg和0.55±0.13（均P＜0.05）;OCT10及OCI预测患者60 d死亡的ROC曲线下面积分别为0.87±0.07（95％ CI：0.69 ～0.96,P＜0.05）及0.83 ±0.18（95％ CI：0.64 ～0.94,P＜0.05）;分别以OCT10=72.00 mmHg及OCI=0.80为最佳界值点,Kaplan-Meier生存曲线分析表明OCT10≥72.00 mmHg及OCI≥0.80患者60 d生存率显著高于0CT10＜ 72.00 mmHg（分别为81.3％和15.4％,X2=7.04,P＜0.01）及OCI＜0.80患者（分别为77.8％和21.7％,X2=13.15,P＜0.01）;多因素logistic回归分析结果显示OCT10（OR=0.88,95％ CI：0.80 ～0.96,P＜0.01）和OCI（OR =0.01,95％ CI：0.001～0.086,P＜0.01）均是患者60 d死亡的独立危险因素.结论 经皮氧分压监测可作为评价ECMO治疗的呼吸衰竭患者预后的有效方法,OCT10及OCI是评估的�Objective To investigate the prognostic value of transcutaneous oximetry in patients with severe acute respiratory failure receiving extracorporeal membrane oxygenation （ECMO）.Methods Forty-nine patients diagnosed as severe acute respiratory failure receiving Venous-Venous （V-V） ECMO were enrolled from January 2013 to December 2015 in intensive care unit （ICU） of Wuxi People＆#39;s Hospital Affiliated to Nanjing Medical University.The 10-min oxygen challenge test was performed using transcutaneous oximetry 6 h after the initiation of ECMO,and the 10-min oxygen challenge test value （OCT10） and oxygen challenge index （OCI） were calculated.The following data were collected：patients＆#39; baseline characteristics,results of arterial blood gas analysis,ventilator settings,APACHE Ⅱ,SOFA and Murray lung injury score.Patients were stratified into the survival group and the death group based on their mortality status at 60 d after initiation of ECMO.Patients＆#39; characteristics and clinical data were analyzed with SPSS 22.0 software.Receiver operating characteristics （ROC） analysis for predicting 60 d mortality was carried out to find area under curve （AUC） and threshold levels of OCT10 and OCI.Analysis of survival probability was carried out by Kaplan-Meier method and log-rank test.Multivariable logistic regression was used to identify factors associated with outcomes.Results There were 25 patients in the survival group and 24 patients in the death group.The characteristics （i.e.,age,sex,primary disease） and clinical data （i.e.,results of arterial blood gas,ventilator settings） of the 2 groups were similar （P 〉 0.05）.The survival group had a significant higher OCT10 and OCI [（77 ± 11） mmHg（1 mmHg =0.133 kPa）,0.77 ± 0.17] than the death group [（57 ± 12） mmHg,0.55 ± 0.13,all P 〈 0.05].The AUC value of OCT10and OCI for predicting 60 d mortality were 0.87 ±0.07（95% CI：0.69-0.96,P 〈0.05） and 0.83 ±0.18 （95% CI：0.64-0.94,P 〈0.05） respectivel

关 键 词：血气监测 经皮 体外膜氧合作用 呼吸功能不全 预后 氧负荷试验 

分 类 号：R563.8[医药卫生—呼吸系统]