探索脓毒症患者最佳脉搏血氧饱和度范围:一项基于MIMIC-Ⅳ数据库的回顾性研究  

Exploring the optimal range of pulse oxygen saturation in patients with sepsis:a retrospective study based on MIMIC-Ⅳdata

作　　者：叶渊文 李飞飞 杨宝华 林连根 陈玲珑 Ye Yuanwen;Li Feifei;Yang Baohua;Lin Liangen;Chen Linglong(Department of Emergency,Wenzhou People's Hospital,Wenzhou 325000,Zhejiang,China)

机构地区：[1]温州市人民医院急诊科,浙江温州325000

出　　处：《中华危重病急救医学》2024年第8期813-820,共8页Chinese Critical Care Medicine

基　　金：浙江省温州市基础性公益科研项目(Y2023575)。

摘　　要：目的探索脓毒症患者住院期间最佳脉搏血氧饱和度(SpO_(2))范围。方法采用病例-对照研究设计。提取美国重症监护医学信息数据库Ⅳ(MIMIC-Ⅳ)脓毒症患者人口统计学信息、生命体征、合并症、实验室参数、危重症评分、临床治疗信息和临床结局等资料。采用广义加性模型(GAM)结合Loess平滑函数,分析并可视化脓毒症患者住院期间SpO_(2)与院内全因病死率的非线性关系,确定最佳SpO_(2)范围,然后利用Logistic回归模型和Kaplan-Meier生存曲线验证SpO_(2)与院内全因病死率的关联性。结果共纳入5937例脓毒症患者,其中1191例(20.1%)在住院期间死亡。GAM分析显示,脓毒症患者住院期间SpO_(2)与院内全因病死率存在非线性关系,呈"U"型曲线,当SpO_(2)在0.96~0.98时病死率最低。经过多因素调整的Logistic回归模型进一步证实,住院期间SpO_(2)在0.96~0.98的患者病死率低于SpO_(2)<0.96的患者〔低氧组,优势比(OR)=2.659,95%可信区间(95%CI)为2.190~3.229,P<0.001〕和SpO_(2)>0.98的患者(高氧组,OR=1.594,95%CI为1.337~1.900,P<0.001)。Kaplan-Meier生存曲线同样表明,住院期间SpO_(2)在0.96~0.98的患者生存概率高于SpO_(2)<0.96和SpO_(2)>0.98的患者(Log-Rank检验:χ^(2)=113.400,P<0.001)。且敏感性分析显示,除样本量较小的亚组外,在年龄、性别、体质量指数(BMI)、入院类型、种族、心率、收缩压、舒张压、平均动脉压、呼吸频率、体温、心肌梗死、充血性心力衰竭、脑血管疾病、慢性肝病、糖尿病、序贯器官衰竭评分(SOFA)、简化急性生理学评分Ⅱ(SAPSⅡ)、全身炎症反应综合征评分(SIRS)、格拉斯哥昏迷评分(GCS)等亚组分层中,SpO_(2)在0.96~0.98患者的病死率较SpO_(2)<0.96和SpO_(2)>0.98的患者明显降低。结论脓毒症患者住院期间SpO_(2)水平与院内全因病死率呈"U"型曲线关系,即高氧与低氧均与死亡风险增加有关,且确定最佳SpO_(2)范围为0.96~0.98。Objective To explore the optimal pulse oxygen saturation(SpO_(2))range during hospitalization for patients with sepsis.Methods A case-control study design was employed.Demographic information,vital signs,comorbidities,laboratory parameters,critical illness scores,clinical treatment information,and clinical outcomes of sepsis patients were extracted from the Medical Information Mart for Intensive Care-Ⅳ(MIMIC-Ⅳ).A generalized additive model(GAM)combined with a Loess smoothing function was employed to analyze and visualize the nonlinear relationship between SpO_(2)levels during hospitalization and in-hospital all-cause mortality.The optimal range of SpO_(2)was determined,and Logistic regression model along with Kaplan-Meier curve were utilized to validate the association between the determined range of SpO_(2)and in-hospital all-cause mortality.Results A total of 5937 patients met the inclusion criteria,among whom 1191(20.1%)died during hospitalization.GAM analysis revealed a nonlinear and U-shaped relationship between SpO_(2)levels and in-hospital all-cause mortality among sepsis patients during hospitalization.Multivariable Logistic regression analysis further confirmed that patients with SpO_(2)levels between 0.96 and 0.98 during hospitalization had a decreased mortality compared to those with SpO_(2)<0.96[hypoxia group;odds ratio(OR)=2.659,95%confidence interval(95%CI)was 2.190-3.229,P<0.001]and SpO_(2)>0.98(hyperoxia group;OR=1.594,95%CI was 1.337-1.900,P<0.001).Kaplan-Meier survival curve showed that patients with SpO_(2)between 0.96 and 0.98 during hospitalization had a higher probability of survival than those patient with SpO_(2)<0.96 and SpO_(2)>0.98(Log-Rank test:χ^(2)=113.400,P<0.001).Sensitivity analyses demonstrated that,with the exception of subgroups with smaller sample sizes,across the strata of age,gender,body mass index(BMI),admission type,race,heart rate,systolic blood pressure,diastolic blood pressure,mean arterial pressure,respiratory rate,body temperature,myocardial infarction,congestive

关 键 词：脓毒症 脉搏血氧饱和度 院内病死率 最佳范围 氧疗 

分 类 号：R459.7[医药卫生—急诊医学]