机械通气患者机械功率暴露强度和持续时间的可视化方法  

Visualization method of mechanical power exposure intensity and duration in mechanical ventilation patients

作　　者：张婧茹 陈志中 龚书榕[3] 陈晗[3] Zhang Jingru;Chen Zhizhong;Gong Shurong;Chen Han(School of Basic Medical Sciences,Fujian Medical University,Fuzhou 350122,Fujian,China;Fujian Foxit Software Development Joint Stock Co.Ltd.,Fuzhou 350003,Fujian,China;Department of Critical Care Medicine,Fujian Provincial Clinical Medical College of Fujian Medical University(Fujian Provincial Hospital),Fujian Provincial Key Laboratory of Critical Care Medicine,Fujian Provincial Center for Critical Care Medicine,Fuzhou 350001,Fujian,China)

机构地区：[1]福建医科大学基础医学院,福州350122 [2]福建省福昕软件开发股份有限公司,福州350003 [3]福建医科大学省立临床医学院(福建省立医院)重症医学科,福建省疑难重症研究重点实验室,福建省重症医学中心,福州350001

出　　处：《中华危重病急救医学》2024年第7期705-711,共7页Chinese Critical Care Medicine

基　　金：福建省卫健委科技计划项目(2021GGA002)。

摘　　要：目的利用可视化方法展现机械通气患者不同机械功率暴露强度-持续时间组合与死亡风险之间的关系。方法从美国重症监护医学信息数据库Ⅳv1.0(MIMIC-Ⅳv1.0)中筛选出接受机械通气的危重病患者,并根据氧合指数(PaO_(2)/FiO_(2))分为4个亚组,即>300 mmHg(1 mmHg≈0.133 kPa)组、201~300 mmHg组、101~200 mmHg组、≤100 mmHg组。收集不同患者人群的基线特征、呼吸机参数及预后指标。对每位患者均使用从低到高的机械功率阈值(5~30 J/min,以1 J/min为间隔递增)评估不同机械功率的暴露情况(高于设定阈值即记录为1次暴露),并根据其对应的持续时间,统计不同暴露强度-持续时间组合的事件次数。根据患者28 d存活/死亡情况,分别计算存活者和死亡者在每种暴露强度-持续时间组合下的暴露次数,并根据暴露次数计算不同机械功率暴露强度-持续时间组合的生存优势比(OR)。以暴露持续时间为横坐标、暴露强度为纵坐标,生成二维表格,并利用热图及其相应等位线视图实现OR值的可视化,从而评估死亡风险。结果最终共纳入5378例接受机械通气的患者,PaO_(2)/FiO_(2)>300 mmHg组2069例,201~300 mmHg组813例,101~200 mmHg组1493例,≤100 mmHg组1003例。随着PaO_(2)/FiO_(2)下降,患者病情严重程度评分〔序贯器官衰竭评分(SOFA)、简化急性生理学评分Ⅱ(SAPSⅡ)〕逐渐升高,合并症比例也呈上升趋势。在呼吸机参数方面,随着PaO_(2)/FiO_(2)下降,患者机械功率逐渐增加〔分别为10.4(7.8,13.9)、11.3(8.5,14.7)、13.6(10.0,18.2)、16.7(12.5,22.0)J/min,P<0.01〕;在预后方面,随着PaO_(2)/FiO_(2)下降,患者28 d病死率逐渐升高〔分别为29.1%(601/2069)、26.9%(219/813)、28.1%(420/1493)、33.3%(334/1003),P<0.05〕。在可视化热图中观察到,机械通气患者28 d死亡风险随着机械功率暴露强度增大和持续时间延长而逐渐增加,表现为两个差异明显的区域:靠近左下角的区域(机械功�Objective To visualize the relationship between different combinations of mechanical power exposure intensity-duration and death risk in mechanical ventilation patients using a visualization method.Methods Critically ill patients receiving mechanical ventilation were selected from the Medical Information Mart for Intensive Care-Ⅳv1.0(MIMIC-Ⅳv1.0)database.The patients were divided into four subgroups according to oxygenation index(PaO_(2)/FiO_(2))including>300 mmHg(1 mmHg≈0.133 kPa)group,201-300 mmHg group,101-200 mmHg group and≤100 mmHg group.The baseline characteristics,ventilator parameters,and prognostic indicators for different patient populations were collected.For each patient,the mechanical power thresholds from low to high(5-30 J/min,increasing at intervals of 1 J/min)were used to evaluate the different exposures of mechanical power(above the set threshold was recorded as one exposure),and the number of events with different exposure intensity-duration combinations was counted based on their corresponding durations.Based on the 28-day survival/non-survival status,the number of exposures for survivors and non-survivors in each exposure intensity-duration combination was calculated,and the survival odds ratio(OR)for different mechanical power exposure intensity-duration combinations was subsequently computed.Two-dimensional tables were generated with mechanical power exposure duration on the x-axis and exposure intensity on the y-axis,and the heatmap and its corresponding equipotential line view were used to visualize the OR value to assess the risk of death.Results A total of 5378 patients receiving mechanical ventilation were enrolled in the study,of whom 2069 patients in the PaO_(2)/FiO_(2)>300 mmHg group,813 patients in the 201-300 mmHg group,1493 patients in the 101-200 mmHg group,and 1003 patients in the≤100 mmHg group.The severity scores of patients,including sequential organ failure assessment(SOFA)score and simplified acute physiology scoreⅡ(SAPSⅡ),gradually increased following the de

关 键 词：机械功率 机械通气 呼吸衰竭 美国重症监护医学信息数据库Ⅳ 病死率 

分 类 号：R459.7[医药卫生—急诊医学]