ROX指数、淋巴细胞指标、血糖对重症肺炎经鼻高流量氧疗后再次气管插管的预测效能及意义  

Efficacy and significance of ROX index,lymphocyte index and blood glucose in predicting retracheal intubation after high-flow nasal cannula oxygen therapy for severe pneumonia

作　　者：林玉霞 陈名智[1] LIN Yuxia;CHEN Mingzhi(Department of Critical Care Medicine,Jinjiang City Hospital in Fujian Province,Jinjiang,Fujian,362600)

机构地区：[1]福建省晋江市医院重症医学科,福建晋江362600

出　　处：《实用临床医药杂志》2024年第6期30-36,共7页Journal of Clinical Medicine in Practice

基　　金：福建省泉州市科技计划项目(2019N006S)。

摘　　要：目的探讨ROX指数、淋巴细胞计数、血糖对重症肺炎经鼻高流量(HFNC)氧疗后再次气管插管的预测效能及意义。方法选取180例重症肺炎机械通气患者为研究对象,均采用有创-高流量氧疗序贯脱机。根据HFNC氧疗后是否再次气管插管机械通气分为再插管组(n=31)和非再插管组(n=149)。比较2组HFNC氧疗前及HFNC氧疗后6、12 h的ROX指数和淋巴细胞指标[淋巴细胞(LYM)计数、辅助/诱导T淋巴细胞(CD4~+T)计数和抑制/细胞毒T淋巴细胞(CD8~+T)计数]及血糖水平。采用随机森林算法对影响再次气管插管的特征变量进行排序与筛选。采用受试者工作特征(ROC)曲线分析ROX指数、淋巴细胞指标及血糖对再次气管插管的预测价值。结果HFNC氧疗后6、12 h,再插管组ROX指数低于非再插管组,血糖高于非再插管组,差异有统计学意义(P<0.05)。随机森林算法显示,重要性排序前3的变量分别是ROX指数、CD4~+T计数、血糖。HFNC氧疗后6、12 h的ROX指数、CD4~+T计数联合血糖预测再次气管插管的曲线下面积(AUC)大于单独指标,且HFNC氧疗后12 h三者联合预测再次气管插管的AUC大于HFNC氧疗后6 h(P<0.05)。结论ROX指数、CD4~+T计数和血糖联合评估对重症肺炎患者HFNC氧疗后再次气管插管机械通气具有一定的预测效能。Objective To investigate the efficacy and significance of Rox index,lymphocyte count and blood glucose in predicting retracheal intubation after high-flow nasal cannula(HFNC)oxygen therapy for severe pneumonia.Methods A total of 180 patients with severe pneumonia were selected as the study subjects,and all patients were treated with invasive and high-flow oxygen therapy sequentially.According to whether mechanical ventilation with re-intubation occurred after HFNC oxygen therapy,the patients were divided into re-intubation group(n=31)and non-re-intubation group(n=149).The ROX index,lymphocyte index[lymphocyte(LYM)count,helper/inducer T lymphocyte(CD4+T)count and suppressor/cytotoxic T lymphocyte(CD8+T)count]and blood glucose levels between the two groups before and at 6 hours and 12 hours after high-flow nasal cannula(HFNC)oxygen therapy were compared.The random forest algorithm was used to sort and screen the characteristic variables affecting retracheal intubation.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of ROX index,lymphocyte index and blood glucose for retracheal intubation.Results The ROX index of the reintubation group was significantly lower at 6 and 12 h after HFNC oxygen therapy,and the blood glucose was significantly higher than that of the non-reintubation group(P<0.05).Random forest algorithm showed that the top 3 variables in importance ranking were ROX index,CD4+T count and blood glucose.ROX index,CD4+T count combined with blood glucose at 6 and 12 h after HFNC oxygen therapy predicted the area under the curve(AUC)of retracheal intubation was greater than that of the single index,and the AUC of the three combined to predict retracheal intubation at 12 h after HFNC oxygen therapy was greater than that at 6 h after HFNC oxygen therapy(P<0.05).Conclusion The combined evaluation of ROX index,CD4+T count and blood glucose has certain predictive efficacy for retracheal intubation mechanical ventilation after HFNC oxygen therapy in patients with severe pneumonia

关 键 词：重症肺炎 经鼻高流量氧疗 ROX指数 淋巴细胞指标 血糖 

分 类 号：R563.1[医药卫生—呼吸系统] R446[医药卫生—内科学] R61[医药卫生—临床医学]