持续指脉氧监测在病毒性肺炎伴低氧血症患者氧疗中的指导价值  

The guiding value of continuous pulse oxygen saturation monitoring in oxygen therapy of viral pneumonia patients with hypoxemia

作　　者：王诗绮 陈幼花 徐小俊 宋玮 李莉 赵新云 孙培莉 WANG Shiqi;CHEN Youhua;XU Xiaojun;SONG Wei;LI Li;ZHAO Xinyun;SUN Peili(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029;Department of Respiratory and Critical Care Medicine,Anxi County Hospital,Quanzhou 362046,China)

机构地区：[1]南京医科大学第一附属医院呼吸与危重症医学科,江苏南京210029 [2]安溪县医院呼吸与危重症医学科,福建泉州362046

出　　处：《南京医科大学学报(自然科学版)》2025年第2期173-184,共12页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家重点研发计划(2018YFC1311900);江苏省研究生科研与实践创新计划项目(SJCX23_0707)。

摘　　要：目的:分析持续脉搏血氧饱和度(pulse oxygen saturation,SpO_(2))即指脉氧监测对肺炎伴低氧血症患者氧疗的指导价值。方法:共纳入病毒性肺炎伴低氧血症患者101例,持续指脉氧监测组56例,常规指脉氧监测组45例。比较两组的住院天数、动脉血气次数、氧疗过程,以及两组治疗第(7±1)天的氧合指数和炎症因子[白介素(interleukin,IL)-6和C反应蛋白(C-reactive protein,CRP)]的差异。根据入院48 h内是否发生氧疗升级事件,将持续指脉氧监测组分成升级组和未升级组并分析两亚组监测数据。分析SpO_(2)及脉率相关参数与炎症和免疫因子的相关性。并分析升级为双水平气道正压通气(bilevel positive airway pressure,BiPAP)氧疗后48 h内再发生氧疗升级事件的SpO_(2)监测数据。使用受试者工作特征(receiver operating characteristic,ROC)曲线分析SpO_(2)监测参数对诊断早期氧疗升级事件的价值。结果:(1)持续指脉氧监测组的动脉血气次数、氧疗启动升级日和到达最高参数日少于常规指脉氧监测组(P<0.05)。与常规指脉氧监测组相比,持续指脉氧监测组入院第(7±1)天的PaO_(2)/FiO_(2)更高,IL-6和CRP的水平更低(P均<0.05)。(2)持续指脉氧监测组监测参数中最低SpO_(2)(SpO_(2L)),平均SpO_(2)(m SpO_(2)),每日SpO_(2)低于86%、88%、90%、92%、94%的时间百分比(T_(86)、T_(88)、T_(90)、T_(92)、T_(94)),24 h内SpO_(2)的标准偏差在升级组和无升级组间差异均有统计学意义(P均<0.05)。IL-6、CRP和免疫球蛋白G与SpO_(2)参数相关。(3)持续指脉氧监测组BiPAP日有突发的SpO_(2)失饱和,并伴有脉率上升的现象,这类低氧事件发现与脱机有关,且SpO_(2)失饱和的下降面积(descending area,DA)在升级组和未升级组间差异有统计学意义。DA诊断BiPAP呼吸支持下早期氧疗升级事件的ROC曲线下面积为0.852(P<0.05),提示DA可作为预测氧疗升级事件的指标。结论:持续指脉氧监测参数T92可�Objective:To analyze the value of continuous finger pulse oxygen saturation(SpO_(2))monitoring in guiding oxygen therapy in pneumonia patients with hypoxemia.Methods:A total of 101 viral pneumonia patients with hypoxemia were enrolled,56 with continuous finger pulse oximetry monitoring and 45 with routine monitoring.Two groups were compared about hospital days,arterial blood gas(ABG)counts,course of oxygen therapy,as well as the differences in blood oxygenation and inflammatory factors[interleukin⁃6(IL⁃6)and C⁃reactive protein(CRP)]on day(7±1).The continuous finger pulse oximetry monitoring group was divided into an escalation group and a no⁃escalation group according to whether or not an oxygen therapy escalation event occurred within 48 h of admission and the monitoring data of the two groups were analyzed.Correlations of finger pulse oximetry and pulse rate⁃related parameters with inflammatory and immune factors were analyzed.Finger pulse oximetry monitoring data were also analyzed in the case of a further oxygen therapy escalation event within 48 h after escalation to bilevel positive airway pressure(BiPAP)oxygen therapy.The value of finger pulse oximetry in diagnosing early oxygen escalation events was explored using receiver operating characteristic(ROC)curve.Results:①The ABG counts,the day of oxygen therapy initiation escalation and reaching the maximum parameters in the continuous finger pulse oximetry monitoring group were less than those in the routine finger pulse oximetry monitoring group(P<0.05).Compared with the routine finger pulse oximetry monitoring group,the continuous finger pulse oximetry monitoring group had higher PaO_(2)/FiO_(2)and lower levels of IL⁃6 and CRP on day(7±1)of admission(P<0.05).②The differences in monitoring parameters in the continuous finger pulse oximetry monitoring group in terms of lowest SpO_(2)(SpO_(2L)),mean SpO_(2)(mSpO_(2)),the percentage of time with daily SpO_(2)below 86%,88%,90%,92%and 94%(T_(86)、T_(88)、T_(90)、T_(92),and T_(94)),and standar

关 键 词：肺炎 低氧血症 脉搏血氧仪 氧疗 指脉氧饱和度 

分 类 号：R563.1[医药卫生—呼吸系统]