血清乳酸浓度、PaO_(2)/FiO_(2)比值对急性呼吸衰竭患者常规氧疗失败的预测价值  

Value of Serum Lactate Concentration,PaO_(2)/FiO_(2) Ratio to Predict Failure of Conventional Oxygen Therapy in Patients with Acute Respiratory Failure

作　　者：吴志飞 高生虎 李杏 柯文玲 WU Zhifei;GAO Shenghu;LI Xing;KE Wenling(Department of Emergency,Guoyao Dongfeng Huaguo Hospital,Shiyan 442008,China;Department of Internal Medicine,Guoyao Dongfeng Huaguo Hospital,Shiyan 442008,China;Department of Pediatric,Shiyan Maternal and Child Health Hospital,Shiyan 42000,China)

机构地区：[1]国药东风花果医院急诊科,十堰442008 [2]国药东风花果医院内一科,十堰442008 [3]十堰市妇幼保健院儿科,十堰442000

出　　处：《微循环学杂志》2025年第1期61-66,共6页Chinese Journal of Microcirculation

摘　　要：目的:分析血清乳酸(LD)浓度、氧合指数[动脉血氧分压(PaO_(2))/吸入氧浓度(FiO_(2))]比值在预测急性呼吸衰竭患者常规氧疗(HFNC)失败中的价值。方法:选择2022-01-2023-10本院收治的160例急性呼吸衰竭患者,均接受HFNC治疗,根据氧疗效果分为有效组(n=115)和失败组(n=45),比较两组患者一般资料,不同时间点LD浓度及PaO_(2)/FiO_(2)比值变化,采用多因素Logistic回归分析HFNC失败的影响因素。采用受试者工作特征(ROC)曲线评估LD、PaO_(2)/FiO_(2)预测HFNC失败的价值。结果:失败组患者APACHEⅡ评分高于有效组(P<0.05);治疗24h、48h时失败组患者LD水平高于有效组,PaO_(2)/FiO_(2)水平低于有效组(P<0.05)。多因素Logistic回归分析显示,APACHEⅡ评分、24h、48hLD是HFNC失败的危险因素,24hPaO_(2)/FiO_(2)、48hPaO_(2)/FiO_(2)是HFNC失败的保护因素(P<0.05)。ROC曲线显示,24h、48hLD及24h、48hPaO_(2)/FiO_(2)单独及联合预测急性呼吸衰竭患者HFNC失败均有一定价值,联合预测的曲线下面积(AUC)更高。结论:血清LD水平和PaO_(2)/FiO_(2)比值对急性呼吸衰竭患者HFNC失败具有一定的预测价值,联合APACHEⅡ评分可更好的指导临床治疗决策。Objective:To explore the value of serum lactate(LD)concentration and oxygenation index(PaO_(2)/FiO_(2))ratio in predicting the failure of conventional oxygen therapy(HFNC)in patients with acute respiratory failure.Method:160 patients with acute respiratory failure admitted to our hospital from January 2022 to October 2023 were selected and all received HFNC treatment.They were divided into an effective group(n=115)and a failure group(n=45)based on the oxygen therapy effect.General information,lactate(LD)concentration,and PaO_(2)/FiO_(2) ratio changes at different time points were compared between the two groups of patients.Multivariate logistic regression analysis was used to identify the influencing factors of HFNC failure.The value of LD and PaO_(2)/FiO_(2) was evaluated in predicting HFNC failure using receiver operating characteristic(ROC)curves.Results:The APACHE II score of the failed group was higher than that of the effective group(P<0.05).The LD level of the failed group was higher than that of the effective group at 24h and 48h of treatment,and the PaO_(2)/FiO_(2) level was lower than that of the effective group(P<0.05).Multivariate logistic regression analysis showed that APACHE II score,24-hour and 48-hour LD were risk factors for HFNC failure,while 24-hour PaO_(2)/FiO_(2) and 48-hour PaO_(2)/FiO_(2) were protective factors for HFNC failure(P<0.05).The ROC curve showed that 24-hour and 48-hour LD,as well as 24-hour and 48-hour PaO_(2)/FiO_(2) alone and in combination,had certain value in predicting HFNC failure in patients with acute respiratory failure.The area under the curve(AUC)of combined prediction is higher.Conclusion:Serum LD levels and PaO_(2)/FiO_(2) ratio have certain predictive value for HFNC failure in patients with acute respiratory failure,and the combination of APACHE II score can provide higher guidance for clinical treatment decisions.

关 键 词：乳酸 PaO_(2)/FiO_(2)比值 急性呼吸衰竭 氧疗 失败 

分 类 号：R563.8[医药卫生—呼吸系统]