入重症监护病房时氧合指数对脓毒症患者30 d病死率的预测价值  

Predictive value of oxygenation index at intensive care unit admission for 30-day mortality in patients with sepsis

作　　者：毕春华[1] 朱曼晨 倪辰 张宗峰 亓志玲[2] 程焕焕 李宗强 郝翠平 Bi Chunhua;Zhu Manchen;Ni Chen;Zhang Zongfeng;Qi Zhiling;Cheng Huanhuan;Li Zongqiang;Hao Cuiping(Comprehensive Medical Training Center,Jining Medical University,Jining 272067,Shandong,China;Department of Critical Care Medicine,Affiliated Hospital of Jining Medical University,Jining 272030,Shandong,China;Clinical College of Jining Medical University,Jining 272067,Shandong,China;School of Nursing,Shandong University of Traditional Chinese Medicine,Jinan 250355,Shandong,China)

机构地区：[1]济宁医学院医学综合实训中心,山东济宁272067 [2]济宁医学院附属医院重症医学科,山东济宁272030 [3]济宁医学院临床学院,山东济宁272067 [4]山东中医药大学护理学院,济南250355

出　　处：《中华危重病急救医学》2025年第2期111-117,共7页Chinese Critical Care Medicine

基　　金：山东省济宁市重点研发计划项目(2023YXNS180)。

摘　　要：目的探讨入重症监护病房(ICU)时氧合指数(PaO_(2)/FiO_(2))对脓毒症患者30 d病死率的预测价值。方法采用回顾性研究方法,选择2015年4月至2023年10月在济宁医学院附属医院ICU住院治疗的脓毒症患者作为研究对象。收集患者的人口统计学信息、合并症、感染部位、入ICU时的生命体征和实验室检查指标、入ICU 24 h内的疾病严重程度评分、治疗情况及预后指标等。根据入ICU时PaO_(2)/FiO_(2)将患者分为Q1组(PaO_(2)/FiO_(2)为4.1~16.4 cmHg,1 cmHg≈1.33 kPa)、Q2组(PaO_(2)/FiO_(2)为16.5~22.6 cmHg)、Q3组(PaO_(2)/FiO_(2)为22.7~32.9 cmHg)、Q4组(PaO_(2)/FiO_(2)为33.0~94.8 cmHg),比较4组患者上述指标的差异。采用多因素Cox回归分析PaO_(2)/FiO_(2)与脓毒症患者患者30 d死亡的关系;绘制受试者工作特征曲线(ROC曲线),对比PaO_(2)/FiO_(2)、序贯器官衰竭评分(SOFA)和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)对脓毒症患者30 d预后的预测价值。结果共纳入1?711脓毒症患者,其中Q1组428例、Q2组424例、Q3组425例、Q4组434例;30 d死亡622例,30 d总病死率为36.35%。4组患者年龄、体质量指数(BMI)、吸烟史、饮酒史、入ICU心率、呼吸频率、APACHEⅡ评分、SOFA评分、格拉斯哥昏迷评分(GCS)、感染部位、合并慢性阻塞性肺疾病(COPD)、血乳酸(Lac)、凝血酶原时间(PT)、白蛋白(Alb)、总胆红素(TBil)、pH值、机械通气比例、机械通气时间、使用血管活性药物比例及最大浓度、ICU住院时间、总住院时间、急性肾损伤发生率、住院病死率、30 d病死率差异均有统计学意义。多因素Cox回归分析显示,在调整混杂因素后,入ICU时的PaO_(2)/FiO_(2)每增加1 cmHg,30 d死亡风险将降低2%〔风险比(HR)=0.98,95%可信区间(95%CI)为0.98~0.99,P<0.001〕,Q4组30 d死亡风险较Q1组降低41%(HR=0.59,95%CI为0.46~0.76,P<0.001)。拟合曲线显示,调整混杂因素后,PaO_(2)/FiO_(2)与30 d病死率呈曲线关系。拐点�Objective To investigate the predictive value of oxygenation index(PaO_(2)/FiO_(2))at intensive care unit(ICU)admission on 30-day mortality in patients with sepsis.Methods A retrospective study was conducted.Patients with sepsis who were hospitalized in the ICU of the Affiliated Hospital of Jining Medical University from April 2015 to October 2023 were enrolled.The demographic information,comorbidities,sites of infection,vital signs and laboratory test indicators at the time of admission to the ICU,disease severity scores within 24 hours of admission to the ICU,treatment process and prognostic indicators were collected.According to the PaO_(2)/FiO_(2) at ICU admission,patients were divided into Q1 group(PaO_(2)/FiO_(2) of 4.1-16.4 cmHg,1 cmHg≈1.33 kPa),Q2 group(PaO_(2)/FiO_(2) of 16.5-22.6 cmHg),Q3 group(PaO_(2)/FiO_(2) of 22.7-32.9 cmHg),and Q4 group(PaO_(2)/FiO_(2) of 33.0-94.8 cmHg).Differences in the indicators across the four groups were compared.Multifactorial Cox regression analysis was used to assess the relationship between PaO_(2)/FiO_(2) and 30-day mortality of patients with sepsis.The predictive value of PaO_(2)/FiO_(2),sequential organ failure assessment(SOFA)and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)on 30-day prognosis of patients with sepsis was analyzed by receiver operator characteristic curve(ROC curve).Results A total of 1711 patients with sepsis were enrolled,including 428 patients in Q1 group,424 patients in Q2 group,425 patients in Q3 group,and 434 patients in Q4 group.622 patients died at 30-day,the overall 30-day mortality was 36.35%.There were statistically significant differences in age,body mass index(BMI),history of smoking,history of alcohol consumption,admission heart rate,respiratory rate,APACHEⅡ score,SOFA score,Glasgow coma score(GCS),site of infection,Combined chronic obstructive pulmonary disease(COPD),blood lactic acid(Lac),prothrombin time(PT),albumin(Alb),total bilirubin(TBil),pH,proportion of mechanical ventilation,duration of mechanical ventilatio

关 键 词：重症监护病房 脓毒症 氧合指数 30 d病死率 

分 类 号：R459.7[医药卫生—急诊医学]