ROX指数在经鼻高流量湿化氧疗治疗Ⅰ型呼吸衰竭中的应用价值  

Application value of ROX index in the treatment of type Ⅰ chronic respiratory failure patients with high-flow nasal cannula oxygen therapy

作　　者：宋建奇 房颖 吕维 王娜 冯晓凯 姜纯国[2] 卜小宁[2] SONG Jianqi;FANG Ying;LYU Wei;WANG Na;FENG Xiaokai;JIANG Chunguo;BU Xiaoning(Department of Respiratory Medicine,Beijing Daxing District Integrated Traditional Chinese Medicine Hospital,Beijing 100076,China;Department of Respiratory and Critical Care Medicine,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100076,China)

机构地区：[1]北京市大兴区中西医结合医院呼吸科,北京100076 [2]首都医科大学附属北京朝阳医院呼吸与危重症医学科,北京100076

出　　处：《新乡医学院学报》2021年第7期671-675,共5页Journal of Xinxiang Medical University

基　　金：2018年度首都卫生发展科研专项(编号:2018-2-1062)。

摘　　要：目的探讨ROX指数在经鼻高流量湿化氧疗(HFNC)治疗Ⅰ型呼吸衰竭患者过程中对气管插管风险的预测作用。方法选择2018年1月至2019年12月北京市大兴区中西医结合医院收治的55例Ⅰ型呼吸衰竭且行HFNC治疗的患者为研究对象,根据HFNC治疗后是否接受有创正压通气分为HNFC失败组(n=19)和HFNC成功组(n=36)。采用单因素分析独立样本t检验或χ^(2)检验比较2组患者年龄、性别、体质量指数(BMI)、合并症构成比、疾病严重程度[急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)评分、CURB-65评分、序贯器官衰竭估计(SOFA)评分]、pH、动脉血二氧化碳分压(PaCO 2)、动脉血氧分压(PaO 2)以及HFNC治疗前、治疗12 h时呼吸频率、心率、氧合指数[PaO 2/吸入氧体积分数(FiO 2)]、ROX指数。对2组间单因素分析有统计学意义的指标进一步行多因素logistic回归分析,应用受试者工作特征(ROC)曲线分析ROX指数对HFNC治疗是否成功的预测价值。结果HFNC治疗成功组与HFNC治疗失败组患者的性别、年龄、BMI、合并症构成比、URB65评分、SOFA评分以及治疗前pH、PaCO 2、PaO 2比较差异无统计学意义(P>0.05),HFNC治疗成功组患者APACHEⅡ评分显著低于HFNC治疗失败组(P<0.05),HFNC治疗前2组患者呼吸频率、心率、氧合指数、ROX指数比较差异无统计学意义(P>0.05);HFNC治疗12 h后,HFNC治疗成功组与HFNC治疗失败组患者呼吸频率、心率比较差异无统计学意义(P>0.05),HFNC治疗成功组患者氧合指数和ROX指数显著高于HFNC治疗失败组(P<0.05)。多因素分析结果显示,HFNC治疗12 h时ROX指数为HFNC治疗是否成功的独立影响因素(OR=1.204,P<0.05),ROC曲线下面积为0.859,95%置信区间:0.746~0.927,P<0.001,截断值为5.95,敏感度为0.778,特异度为0.895。结论HFNC治疗Ⅰ型呼吸衰竭过程中,HFNC治疗12 h时ROX指数对气管插管风险具有良好的预测作用。Objective To explore the application value of ROX index in treatment of typeⅠchronic respiratory failure patients whit high-flow nasal cannula oxygen therapy(HFNC).Methods A total of 55 patients with typeⅠchronic respiratory failure treated with HFNC admitted to Beijing Daxing District Integrated Traditional Chinese Medicine Hospital from January 2018 to December 2019 were selected as the research subjects,they were divided into the HFNC treatment failure group(n=19)and HFNC treatment success group(n=36)according to the need of invasive positive pressure ventilation or not after HFNC.Univariate analysis was used to analyze the composition,age,gender,body mass index(BMI),constituent ratio of complications,severity of disease[acute physiological and chronic health statusⅡ(APACHEⅡ)score,CURB-65 score,sequential organ failure assessment(SOFA)score],pH,arterial partial pressure of carbon dioxide(PaCO 2),arterial partial pressure of oxygen(PaO 2),and respiratory rate,heart rate,heart rate,heart rate,oxygenation index[PaO 2/fraction of inspiration O 2(FiO 2)]and ROX index before and 12 hours after HFNC treatment between the two groups by independent sample t test andχ^(2) test.Multivariate logistic regression analysis was performed for the indexes with statistical significance in univariate analysis between the two groups,the receiver operating characteristic(ROC)curve was used to analyze the predictive value of ROX index for the risk of endotracheal intubation.Results There was no significant difference in the gender,age,BMI,constituent ratio of complications,URB65 score,SOFA score,pH,PaCO 2 and PaO 2 before treatment between the two groups(P>0.05).The APACHEⅡscore in the HFNC treatment success group were significantly lower than those in the HFNC treatment failure group(P<0.05).There was no significant difference in respiratory rate,heart rate,oxygenation index and ROX index of patients between the two groups before HFNC treatment(P>0.05);At 12 hours of HFNC treatment,there was no significant difference in

关 键 词：高流量湿化氧疗 Ⅰ型呼吸衰竭 ROX指数 气管插管 

分 类 号：R563.1[医药卫生—呼吸系统]