优化氧疗措施对COVID-19患者器官功能及预后的影响  

Effect of optimizing oxygen therapy on multiple organ function and prognosis of patients with COVID-19

作　　者：郑兴龙[1] 陈仁洲 李敏然 李锦忠 陈丽[4] 吴义[4] 汪志刚[1] ZHENG Xing-long;CHEN Ren-zhou;LI Min-ran;LI Jin-zhong;CHEN Li;WU Yi;WANG Zhi-gang(Department of Intensive Medicine,The First Affiliated Hospital,Jinan University,Guangzhou 510632,China;Wuhan Hankou Hospital,Wuhan 430012,China;Department of Infectious Disease,The First Affiliated Hospital,Jinan University,Guangzhou 510632,China;Department of Respiratory Medicine,The First Affiliated Hospital,Jinan University,Guangzhou 510632,China)

机构地区：[1]暨南大学附属第一医院重症医学科,广东广州510630 [2]武汉市汉口医院,湖北武汉430012 [3]暨南大学附属第一医院感染科,广东广州510630 [4]暨南大学附属第一医院呼吸科,广东广州510630

出　　处：《中国病理生理杂志》2021年第5期909-914,共6页Chinese Journal of Pathophysiology

摘　　要：目的:在新型冠状病毒肺炎(COVID-19)疫情爆发的早期阶段,通过优化氧疗资源的措施,使所有患者得到合适的氧疗,观察对患者病情的改善和预后的影响。方法:观察对象为COVID-19确诊患者,共有127例患者入组。以优化氧疗措施的实施日期为分界点,各取前后15 d内入院的患者(患者相对最多的时间段)。将患者分为两组:(1)优化氧疗措施前入院的患者,这些患者无论轻重,主要通过中心供氧系统供氧,共52例;(2)优化氧疗措施后入院的患者,这些患者分为轻症、普通、重症和危重症患者,轻症患者予以中心供氧系统吸氧,普通患者予以家用制氧机吸氧,重症患者予以氧气筒吸氧,危重症患者予以机械通气,共75例。观察指标为生命体征、血常规和凝血功能、心脏、肝脏和肾脏功能等指标,同时观察对住院时间和死亡率的影响。结果:两组患者的基本临床资料比较无统计学的差异。优化氧疗措施后入院的患者生命体征得到改善,尤其是血氧饱和度(SpO2)明显好转(P<0.01)。凝血功能紊乱减轻,表现为D-二聚体升高减轻(P<0.01)。患者的炎症反应得到一定程度的抑制,表现为C反应蛋白(CRP)的降低(P<0.05)。经过对年龄、性别和病情危重程度等危险因素的调整,优化氧疗后患者死亡率明显下降(P<0.01)。结论:在COVID-19疫情大规模爆发期间,尽快使氧疗资源优化是重要的措施,使所有患者得到尽可能有效的氧疗,从而提高氧合而改善患者病情及其预后。AIM:At the early stage of coronavirus disease 2019(COVID-19)outbreak,by optimizing oxygen therapy resources,all patients were given appropriate oxygen therapy to observe the effect on the improvement of the pa-tients’condition and prognosis.METHODS:The subjects were patients diagnosed with COVID-19,and 127 patients were enrolled in the group.By taking the measures of optimizing oxygen therapy(OOT)as the time dividing point,the pa-tients who were admitted within 15 d before and after OOT were enrolled(the period with the most patients).The patients were divided into 2 groups:(1)52 patients were admitted before OOT,and they only received oxygen therapy by central oxygen supply system regardless severity of the condition;(2)75 patients were admitted after OOT.These patients admit-ted after OOT were divided into mild,general,severe and critical subgroups,and received oxygen therapy by central oxy-gen supply system,household oxygen making machine,oxygen tubes,and mechanical ventilation,respectively.The out-come measures were vital signs,the indexes of complete blood count(white blood cells,neutrophils,etc),blood coagula-tion(D-dimer),heart(NT-proBNP and lactate dehydrogenase),liver(aminotransferases and bilirubin)and kidney(se-rum creatinine and bllod urea nitrogen),and the hospitalization time and mortality were also observed.RESULTS:No statistically difference in the basic clinical data between 2 groups was observed.The vital signs of the patients were im-proved after OOT,especially the pulse oximetric saturation(SpO2)was significantly improved(P<0.01).The coagulation disorder was alleviated,such as the increase of D dimer was significantly lower after OOT(P<0.01).The inflammatory re-action of the patients was inhibited to a certain extent,which was manifested as the decrease of C reactive protein(CRP)finally(P<0.05).After adjusting the risk factors such as age,gender and severity of illness,the mortality of the patients was decreased significantly(P<0.01).CONCLUSION:During the large-scale outbreak of COVID-19,it

关 键 词：新型冠状病毒肺炎 优化氧疗 器官功能 预后 

分 类 号：R563.14[医药卫生—呼吸系统] R363.2[医药卫生—内科学]