PaO_(2)和PCT联合ROX指数预测重症急性胰腺炎患者气管插管时机  

Arterial partial pressure of oxygen and procalcitonin combined with ROX index predict the timing of tracheal intubation in patients with acute severe pancreatitis

作　　者：宁凤玲 韩小彤[1,2,3,4] 樊麦英 田馨怡[1,2,3,4] 文辉 晏锡泉[1,2,3,4] 高敏 李想[1,2,3,4] Ning Fengling;Han Xiaotong;Fan Maiying;Tian Xinyi;Wen Hui;Yan Xiquan;Gao Min;Li Xiang(Department of Emergency Medicine,Hunan Provincial People's Hospital,the First Affiliated Hospital of Hunan Normal University,Changsha 410002,Hunan,China;Clinical Research Center for Emergency and Critical Care,Changsha 410209,Hunan,China;Hunan Provincial Institute of Emergency Medicine,Changsha 410209,Hunan,China;Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics,Changsha 410005,Hunan,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)急诊医学科,长沙410002 [2]湖南省急危重症临床医学研究中心,长沙410209 [3]湖南省急救医学研究所,长沙410209 [4]急危重症代谢组学湖南省重点实验室,长沙410005

出　　处：《中华危重病急救医学》2023年第7期752-756,共5页Chinese Critical Care Medicine

基　　金：湖南创新型省份建设专项(2020SK1010)。

摘　　要：目的探讨动脉血氧分压(PaO2)、降钙素原(PCT)联合ROX指数预测重症急性胰腺炎(SAP)患者气管插管时机的有效性。方法采用病例对照研究方法,选择湖南省人民医院2019年1月至2022年12月收治的148例SAP患者为研究对象,根据入院后是否采用气管插管治疗将患者分为插管组(102例)和未插管组(46例)。比较两组患者性别、年龄、白细胞计数(WBC)、淋巴细胞计数(LYM)、血小板计数(PLT)、C-反应蛋白(CRP)、血红蛋白(Hb)、PCT、PaO_(2)、动脉血二氧化碳分压(PaCO_(2))、入院1 d动脉血碳酸氢根离子(HCO_(3)^(-))、动脉血乳酸(Lac)、乳酸脱氢酶(LDH)、心率(HR)、呼吸频率(RR)、脉搏血氧饱和度(SpO_(2))、氧合指数(PaO_(2)/FiO_(2))、血压、入院30 min内和插管前30 min内最差ROX指数(ROX指数=SpO_(2)/FiO_(2)/RR)等指标。采用多因素Logistic回归分析SAP患者气管插管时机的独立危险因素;采用受试者工作特征曲线(ROC曲线)确定最佳气管插管预测截断值。结果两组患者年龄、性别及入院时WBC、LYM、CRP、Hb、LDH、HR、血压比较差异均无统计学意义。插管组PLT、Lac、PCT、RR明显高于未插管组,HCO3-、PaO2、SpO2、PaO2/FiO2、入院30 min内和插管前30 min内最差ROX指数明显低于未插管组(均P<0.05)。Logistic回归分析显示,插管前30 min内最差ROX指数是SAP患者气管插管时机最大的负向影响因素〔优势比(OR)=0.723,95%可信区间(95%CI)为0.568~0.896,P=0.000〕,其次是PaO2(OR=0.872,95%CI为0.677~1.105,P<0.001);PCT是其正向影响因素(OR=1.605,95%CI为1.240~2.089,P<0.001)。ROC曲线分析显示,PaO2、PCT、插管前30 min内最差ROX指数和三者联合评估SAP患者气管插管时机的ROC曲线下面积(AUC)分别为0.715、0.702、0.722和0.808,敏感度分别为78.1%、75.0%、81.5%和89.3%,特异度分别为66.7%、59.0%、73.2%和86.4%,最佳截断值分别为60.23 mmHg(1 mmHg≈0.133 kPa)、2.72 μg/L、4.85和0.58。PaO2、PCT联合插管前30 min内�Objective To investigate the efficacy of arterial partial pressure of oxygen(PaO_(2)),procalcitonin(PCT)combined with ROX index in predicting the timing of tracheal intubation in patients with acute severe pancreatitis(SAP).Methods A case-control study was conducted.A total of 148 patients with SAP admitted to Hunan Provincial People's Hospital from January 2019 to December 2022 were selected as the research objects.According to whether endotracheal intubation was used after admission during hospitalization,the patients were divided into the intubation group(102 cases)and non-intubation group(46 cases).Gender,age,white blood cell count(WBC),lymphocyte count(LYM),platelet count(PLT),C-reactive protein(CRP),hemoglobin(Hb),PCT,PaO2,arterial partial pressure of carbon dioxide(PaCO2),arterial bicarbonate ion(HCO3-)1 day after admission,arterial lactic acid(Lac),lactate dehydrogenase(LDH),heart rate(HR),respiratory rate(RR),pulse oxygen saturation(SpO2),oxygenation index(PaO2/FiO2),blood pressure,worst ROX index(ROX index=SpO2/FiO2/RR)within 30 minutes of admission and 30 minutes before intubation of the two groups were measured.Multivariate Logistic regression was used to analyze the independent risk factors for the timing of endotracheal intubation in patients with SAP.The receiver operator characteristic curve(ROC curve)was used to determine the optimal predictive cut-off value for endotracheal intubation.Results There were no significant differences in age,gender,WBC,LYM,CRP,Hb,LDH,HR and blood pressure at admission between the two groups.The PLT,Lac,PCT and RR in the intubation group were significantly higher than those in the un-intubation group,and HCO3-,PaO2,SpO2,PaO2/FiO2,the worst ROX index within 30 minutes after admission and 30 minutes before intubation were significantly lower than those in the non-intubation group(all P<0.05).Logistic regression analysis showed that the worst ROX index within 30 minutes before intubation was the largest negative influencing factor for the timing of tracheal intubation in

关 键 词：重症急性胰腺炎 ROX指数 动脉血氧分压 降钙素原 气管插管 插管时机 

分 类 号：R576[医药卫生—消化系统]