云南省不同高海拔地区不同类型ARDS患者用SpO_(2)/FiO_(2)与PaO_(2)/FiO_(2)评估氧合的比较  

Comparison of pulse oxygen saturation/fraction of inhaled oxygen and arterial partial pressure of oxygen/fraction of inhaled oxygen in the assessment of oxygenation in acute respiratory distress syndrome patients at different high altitudes in Yunnan Province

作　　者：许汪斌[1] 李春明 陈耀武 段华楠 刁璐 杨潇[1] 代冬梅[1] 肖李乐云[1] 王飞[1] Xu Wangbin;Li Chunming;Chen Yaowu;Duan Huanan;Diao Lu;Yang Xiao;Dai Dongmei;Xiao-Li Leyun;Wang Fei(Department of Intensive Care Unit,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan,China;Department of Intensive Care Unit,Diqing Tibetan Autonomous Prefectural People's Hospital,Diqing 674400,Yunnan,China;Department of Emergency Medicine,People's Hospital of Lijiang,Lijiang 674100,Yunnan,China)

机构地区：[1]昆明医科大学第一附属医院重症医学科,云南昆明650032 [2]迪庆藏族自治州人民医院重症医学科,云南迪庆674400 [3]丽江市人民医院急救医学部,云南丽江674100

出　　处：《中华危重病急救医学》2021年第7期826-831,共6页Chinese Critical Care Medicine

基　　金：云南省昆明市新型冠状病毒感染肺炎科技防治项目(2020-1-H-052)。

摘　　要：目的针对云南省不同高海拔地区不同类型急性呼吸窘迫综合征(ARDS)患者,探讨是否可以用脉搏血氧饱和度/吸入氧浓度(SpO_(2)/FiO_(2))替代动脉血氧分压/吸入氧浓度(PaO_(2)/FiO_(2))来评估其氧合情况,以寻找适用于不同海拔地区、能快速且无创诊断ARDS的方法。方法选择2019年1月至2020年12月云南省不同高海拔地区ARDS患者。依据不同海拔高度将研究对象分为3组,并根据各自的医疗条件给予不同的氧疗。第1组为昆明医科大学第一附属医院重症医学科收治的中度和重度ARDS患者(平均海拔约1800 m);给予呼吸机辅助通气,并以较低的FiO_(2)维持SpO_(2)为0.90~0.96,持续超过30 min后记录SpO_(2)、FiO_(2)、PaO_(2)。第2组为迪庆藏族自治州人民医院重症医学科收治的中度和重度ARDS患者(平均海拔约3200 m);给予储气囊面罩吸氧,维持SpO_(2)为0.90~0.96,持续10 min后记录SpO_(2)、FiO_(2)、PaO_(2)。第3组为丽江市人民医院急诊科收治的轻度和中重度ARDS患者(平均海拔约2200 m);当SpO_(2)<0.90时,给予储氧面罩吸氧,记录维持SpO_(2)≥0.90所需FiO_(2),吸氧10 min后记录SpO_(2)、FiO_(2)、PaO_(2)。使用Spearman系数对各组SpO_(2)/FiO_(2)与PaO_(2)/FiO_(2)进行相关性分析;采用线性分析推导SpO_(2)/FiO_(2)与PaO_(2)/FiO_(2)之间的线性方程,并评估动脉血pH值、动脉血二氧化碳分压(PaCO_(2))、FiO_(2)、潮气量(VT)、呼气末正压(PEEP)等相关因素是否为改变SpO_(2)/FiO_(2)与PaO_(2)/FiO_(2)相关性的影响因子。绘制受试者工作特征曲线(ROC曲线),计算使用SpO_(2)/FiO_(2)替代PaO_(2)/FiO_(2)评估ARDS患者氧合的敏感度和特异度。结果第1组24例患者共收集271个血气分析结果;第2组14例患者共收集47个血气分析结果;第3组76例患者共收集76个血气分析结果。第1组、第2组、第3组的PaO_(2)/FiO_(2)(mmHg,1 mmHg=0.133 kPa)分别为103(79,130)、168(98,195)、232(146,271),而SpO_(2)/FiO_(2)分别为157(128,1Objective To investigate and evaluate if pulse oxygen saturation/fraction of inhaled oxygen(SpO_(2)/FiO_(2))can be used,as replacement of arterial partial pressure of oxygen/fraction of inhaled oxygen(PaO_(2)/FiO_(2)),to assess oxygenation in acute respiratory distress syndrome(ARDS)patients at different high altitudes in Yunnan Province,and to find a rapid and non-invasive method for the diagnosis of ARDS at different altitudes.Methods Patients with ARDS at different high altitudes in Yunnan Province from January 2019 to December 2020 were enrolled.The patients were divided into three groups according to different altitudes,and received different oxygen therapies according to their respective medical conditions.Group 1 consisted of patients with moderate to severe ARDS from the department of critical care medicine of the First Affiliated Hospital of Kunming Medical University(average altitude approximately 1800 m),and received mechanical ventilation to maintain SpO_(2)of 0.90-0.96 with a low FiO_(2)for more than 30 minutes,and SpO_(2),FiO_(2),PaO_(2)were recorded.Group 2 consisted of patients with moderate to severe ARDS at the department of critical care medicine of People's Hospital of Diqing Tibetan Autonomous Prefecture(mean altitude about 3200 m),and received oxygen with an attached reservoir mask to maintain SpO_(2)of 0.90-0.96 for 10 minutes,and then SpO_(2),FiO_(2),and PaO_(2)were recorded.Group 3 consisted of patients with mild to moderate-severe ARDS who admitted to the emergency department of the People's Hospital of Lijiang(average altitude approximately 2200 m);when SpO_(2)<0.90,patients received oxygen with the oxygen storage mask,and the FiO_(2)required to maintain SpO_(2)≥0.90 was recorded,and SpO_(2),FiO_(2),PaO_(2)were recorded after oxygen inhalation for 10 minutes.Spearman coefficient was used to analyze the correlation between SpO_(2)/FiO_(2)and PaO_(2)/FiO_(2)in each group.Linear analysis was used to derive the linear equation between SpO_(2)/FiO_(2)and PaO_(2)/FiO_(2),and to evaluate art

关 键 词：急性呼吸窘迫综合征 动脉血氧分压 脉搏血氧饱和度 吸入氧浓度 

分 类 号：R563.8[医药卫生—呼吸系统]