ROX指数对新型冠状病毒肺炎患者经鼻高流量湿化氧疗疗效的评估价值  

The value of ROX index in evaluating the efficacy of high-flow nasal cannula oxygen therapy in patients with COVID-19

作　　者：笪伟[1] 何媛媛 王晓波 徐爱晖[2] 李永怀[2] 许夕海[3] 张泓[1] Da Wei;He Yuanyuan;Wang Xiaobo;Xu Aihui;Li Yonghuai;Xu Xihai;Zhang Hong(Department of Emergency Medicine,the First Affiliated Hospital of Anhui Medical University,Hefei 230032,China;Department of Respiratory and Critial Medicine,the First Affiliated Hospital of Anhui Medical University,Hefei 230032,China;Department of Infection,the First Affiliated Hospital of Anhui Medical University,Hefei 230032,China)

机构地区：[1]安徽医科大学第一附属医院急诊科,合肥230032 [2]安徽医科大学第一附属医院呼吸与危重症科,合肥230032 [3]安徽医科大学第一附属医院感染病科,合肥230032

出　　处：《中华急诊医学杂志》2021年第5期588-592,共5页Chinese Journal of Emergency Medicine

摘　　要：目的探讨ROX指数在评估新型冠状病毒肺炎(COVID-19)患者经鼻高流量湿化氧疗(high-flow nasal cannula oxygen therapy,HFNC)治疗效果的价值。方法回顾性分析2020年2月15日至2020年3月15日华中科技大学同济医学院附属协和医院肿瘤中心重症病区收治的接受HFNC的符合重症COVID-19诊断标准的患者的临床资料。根据患者后续是否接受无创正压通气、有创正压通气,将其分为HFNC治疗成功组与HFNC治疗失败组,使用t检验、χ2检验或者秩合检验比较两组在基本资料、乳酸、胸片肺部感染所占象限数、APACHEⅡ、淋巴细胞计数、基线呼吸频率、基线经皮氧饱和度、基线氧合指数、基线ROX指数、HFNC治疗2 h后ROX指数、HFNC治疗6 h后ROX指数、HFNC治疗12 h后ROX指数之间的差异。结果共有57例患者纳入本研究。成功组与失败组在性别、年龄、合并症、乳酸、胸片肺部感染所占象限数、APACHEⅡ、淋巴细胞计数、基线呼吸频率、基线经皮氧饱和度、基线氧合指数、基线ROX指数差异均无统计学意义(P>0.05),Logistic回归分析结果提示,治疗2 h ROX(OR=0.069)、治疗6 h ROX(OR=0.194)、治疗12 h ROX(OR=0.036)均为COVID-19患者HFNC治疗效果的保护因素,ROC曲线示,HFNC治疗2 h、6 h、12 h后ROX指数差异有统计学意义(P<0.05)。在评价指标中HFNC治疗2 h后ROX指数ROC曲线下面积(AUC)0.838,灵敏度为64.5%,特异度为100%。HFNC治疗6 h后ROX指数AUC为0.762,灵敏度为64.5%,特异度为92.3%。HFNC治疗12 h后ROX指数AUC为0.866,灵敏度为67.7%,特异度为100%。结论ROX指数可以及时、简便、实时地在评估COVID-19患者HFNC治疗效果。Objective To assess the value of the ROX index in evaluating the efficacy of highflow nasal cannula oxygen therapy(HFNC)in patients with coronavirus infected disease(COVID-19).Methods This is a retrospective study.The included patients were diagnosed as COVID-19 in the intensive care unit(ICU)of the Cancer Center of Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from February 15,2020 to March 15,2020.All the patients were treated by HFNC.According to whether the patient subsequently received non-invasive positive pressure ventilation or invasive positive pressure ventilation,patients were divided into the HFNC success group and the HFNC failure group.Parameters in the two groups such as basic characteristics,lactic acid,number of chest radiographs,APACHE II,lymphocyte count,baseline respiratory rate,baseline percutaneous oxygen saturation,baseline PaO2/FiO2,baseline ROX index,and ROX index after 2,6 and 12 h HFNC treatment were analyzed with t test,Chi-square test or rank sum test.Results A total of 57 cases were included in this study.There were no significant differences in sex,age,comorbidities,lactic acid,quadrants of chest radiograph lung infection,APACHE II,lymphocyte count,and baseline respiratory frequency,transcutaneous oxygen saturation,oxygenation index,and ROX index between the HFNC success group and the HFNC faliure group(P>0.05).Logistic regression analysis showed that ROX index after 2 h HFNC treatment(OR=0.069),ROX index after 6 h HFNC treatment(OR=0.194)and ROX index after 12 h HFNC treatment(OR=0.036)were all protective factors for the therapeutic effect of HFNC treatment in COVID-19 patients.ROC curve showed that there were significant differences in ROX index after 2 h HFNC treatment,ROX index after 6 h HFNC treatment,and ROX index after 12 h HFNC treatment(P<0.05).In the evaluation index,the area under the ROC curve of the ROX index after 2 h HFNC treatment was 0.838,the sensitivity was 64.5%,and the specificity was 100%.After 6 h HFNC tre

关 键 词：经鼻高流量湿化氧疗 新型冠状病毒肺炎 机械通气 ROX指数 

分 类 号：R563.1[医药卫生—呼吸系统]