COPD合并轻度高碳酸血症患者高流量氧疗的效果观察--一项基于MIMIC-Ⅳ数据库的回顾性队列研究  

Effect of high-flow nasal cannula oxygen on patients with chronic obstructive pulmonary disease and mild hypercapnia:a retrospective cohort study based on the Medical Information Mart for Intensive Care-Ⅳ database

作　　者：刘韬滔[1] 赵沁宇 史展 杜斌 Liu Taotao;Zhao Qinyu;Shi Zhan;Du Bin(Department of Surgical Intensive Care Unit(ICU),Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;College of Engineering and Computer Science,Australian National University,Canberra 2600,Australia;Department of Medical ICU,State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]北京医院,国家老年医学中心,中国医学科学院老年医学研究院外科ICU,北京100730 [2]澳洲国立大学工程与计算机科学学院,堪培拉2600 [3]中国医学科学院,北京协和医学院,北京协和医院内科ICU,北京100730

出　　处：《中华危重病急救医学》2021年第6期686-691,共6页Chinese Critical Care Medicine

基　　金：基于医疗大数据人工智能科研课题(ZMX2020-121)。

摘　　要：目的观察经鼻高流量氧疗(HFNC)对慢性阻塞性肺疾病(COPD)合并高碳酸血症患者的临床疗效,并评估生理参数指标对COPD合并轻度高碳酸血症患者疗效的早期预测价值。方法采用回顾性队列研究方法,选择美国重症监护医学信息数据库-Ⅳ(MIMIC-Ⅳ)截至2020年9月发布的2008至2019年COPD合并轻度高碳酸血症患者的相关记录〔45 mmHg(1 mmHg=0.133 kPa)<动脉血二氧化碳分压(PaCO_(2))≤60 mmHg〕。根据接受HFNC或无创呼吸机分为HFNC组和无创通气(NIV)组。收集入选患者的性别、年龄、体质量指数(BMI)、简化急性生理学评分Ⅱ(SAPSⅡ)、查尔森合并症指数(CCI)评分、生理参数等基线数据。根据HFNC组基线数据进行倾向评分匹配,比较两组患者治疗48 h和28 d插管率、28 d病死率、重症监护病房(ICU)住院时间、总住院时间,以及治疗48 h内各时间段的生理参数的差异。绘制受试者工作特征曲线(ROC曲线),分析治疗4 h心率/脉搏血氧饱和度(HR/SpO_(2))比值及ROX指数〔SpO_(2)/(吸入氧浓度,FiO_(2)×呼吸频率,RR)〕预测24 h与48 h插管的准确性。结果共筛查524520份住院记录,纳入患者153例,其中HFNC组37例,NIV组116例。根据基线数据进行倾向性评分匹配后HFNC组患者31例,NIV组患者84例。两组患者性别、年龄、BMI、SAPSⅡ、CCI评分、生理参数等基线数据以及除ICU住院时间外的预后指标比较差异均无统计学意义。HFNC组ICU住院时间较NIV组明显延长〔d:4.6(3.1,10.0)比3.1(1.6,5.8),P<0.05〕。与0-8 h比较,治疗40-48 h HR、RR仅HFNC组明显降低〔HR(次/min):84.1±12.2比91.1±16.4,RR(次/min):19.8±4.9比21.6±4.1,均P<0.05〕;而HFNC组和NIV组pH值均明显升高(7.42±0.08比7.36±0.05,7.41±0.06比7.36±0.05,均P<0.05),PaCO_(2)均明显降低〔mmHg:46.3(39.5,51.0)比49.8(45.5,54.0),46.0(40.5,51.5)比49.5(46.5,55.3),均P<0.05〕。与HFNC组同期比较,治疗40-48 h NIV组HR、PaO_(2)均升高〔HR(次/min):91.1±15.4比84Objective To observe the effect of high-flow nasal cannula oxygen therapy(HFNC)in patients with chronic obstructive pulmonary disease(COPD)and mild hypercapnia,and to evaluate the early predictive ability of physiological parameters in these patients.Methods A retrospective cohort study was conducted based on Medical Information Mart for Intensive Care-Ⅳ(MIMIC-Ⅳ)updated in September 2020 and the data of adult patients with COPD and mild hypercapnia[45 mmHg(1 mmHg=0.133 kPa)<arterial partial pressure of carbon dioxide(PaCO_(2))≤60 mmHg]from 2008 to 2019 were collected.These patients were assigned to the HFNC group or non-invasive ventilation(NIV)group according to whether they received HFNC or NIV.Baseline data such as gender,age,body mass index(BMI),simplified acute physiology scoreⅡ(SAPSⅡ),Charlson comorbidity index(CCI)and physiological parameters were collected.A propensity score matching was conducted according to the baseline data of the HFNC group patients.The 48-hour and 28-day intubation rates,28-day mortality,length of intensive care unit(ICU)stay,the length of hospital stay,and the changes in physiological parameters within 48 hours after treatment were compared between the two groups.The receiver operating characteristic curve(ROC curve)was drawn and the ratio of heart rate over pulse oxygen saturation(HR/SpO_(2))and ROX index[SpO_(2)/(inhaled oxygen concentration,FiO_(2)×respiratory rate,RR)]were analyzed to predict the 24-hour and 48-hour intubation rates.Results A total of 524520 inpatient records were screened and 153 patients were included,while 37 patients in the HFNC group and 116 patients in NIV group.There were 31 patients in the HFNC group and 84 patients in the NIV group remained after propensity score matching according to the baseline data.There were no significant differences in the baseline data of gender,age,BMI,SAPSⅡ,CCI score,physiological parameters and prognosis data except the length of ICU stay.The length of ICU stay in HFNC group was significant longer than that of t

关 键 词：经鼻高流量氧疗 慢性阻塞性肺疾病 无创机械通气 重症监护医学信息数据库-Ⅳ 

分 类 号：R563.9[医药卫生—呼吸系统]