摘要
目的分析重症患者高氧血症的发生情况、临床特征及危险因素。方法采用回顾性研究方法。收集2017年6月至2018年10月就诊于贵州医科大学附属医院综合重症监护病房(ICU)进行常规氧疗患者的一般情况、入住ICU时和住ICU期间的血气结果、有无ICU内新发感染、有无机械通气、机械通气时间及ICU住院时间、ICU病死率等临床资料。按入住ICU 6 h后至离开ICU期间是否发生高氧血症将患者分为发生高氧血症组与未发生高氧血症组〔高氧血症的定义为动脉血氧分压(PaO_(2))≥120 mmHg(1 mmHg≈0.133 kPa)〕。比较是否发生高氧血症两组患者上述资料的差异;采用Logistic回归分析筛选出影响患者发生高氧血症的因素,并绘制受试者工作特征曲线(ROC曲线),分析各危险因素对患者发生高氧血症的预测价值。结果共纳入392例患者,入住ICU时高氧血症占34.4%(135/392);而ICU内高氧血症占56.6%(222/392)。ICU内发生高氧血症组患者较未发生高氧血症组患者年龄更小〔岁:56(39,71)比62(46,72)〕,体质量指数更低〔kg/m^(2):21.5(19.5,23.6)比22.5(20.0,25.0)〕,有更长的机械通气时间〔h:82.0(43.0,161.0)比67.5(37.8,127.0)〕和ICU住院时间〔d:6.0(4.0,11.8)比4.0(3.0,8.0)〕,机械通气比例、入住ICU时和ICU内PaO_(2)、ICU内吸入氧浓度、入住ICU时和ICU内氧合指数(PaO_(2)/FiO_(2))、入ICU时动脉血乳酸(Lac)、ICU内新发感染比例均相对更高〔机械通气比例:86.0%(191/222)比71.8%(122/170),入住ICU时PaO_(2)(mmHg):110.5(85.5)比76.0(41.8),ICU内PaO_(2)(mmHg):138.0(29.0)比76.0(22.8),ICU内吸入氧浓度:0.33(0.15)比0.30(0.15),入住ICU时PaO_(2)/FiO_(2)(mmHg):279.5(173.0,400.0)比208.0(153.0,305.0),ICU内PaO_(2)/FiO_(2)(mmHg):436.7(348.0,528.0)比249.0(190.0,331.0),入住ICU时Lac(mmol/L):2.5(2.9)比1.7(2.2),ICU内新发感染比例:45.0%(100/222)比31.2%(53/170)〕,差异均有统计学意义(均P<0.05);而发生高氧血症组与未发生高氧血症组ICU内
Objective To analyze the incidence,clinical characteristics and risk factors of hyperoxemia in crtically ill patients.Methods A retrospective study was conducted.Clinical data of patients admitted to the department of comprehensive intensive care unit(ICU)of the Affiliated Hospital of Guizhou Medical University from June 2017 to October 2018 were collected,including general conditions of routine oxygen therapy,blood gas results at ICU admission and during ICU stay,new infections in ICU,mechanical ventilation,mechanical ventilation duration and length of ICU stay.Patients were divided into a hyperoxemia group and a non-hyperoxemia group according to whether hyperoxemia occurred from 6 hours after ICU admission until ICU discharge[defined as arterial partial pressure of oxygen(PaO_(2))≥120 mmHg(1 mmHg≈0.133 kPa)].The differences in clinical data between the two groups were compared.Logistic regression analysis was used to screen for factors that affected the occurrence of hyperoxemia in patient;receiver operator characteristic curve(ROC curve)was plotted to analyze the predictive value of each risk factor for the occurrence of hyperoxemia in patients.Results A total of 392 patients were included,among whom 34.4%(135/392)experienced hyperoxemia upon admission to the ICU,while 56.6%(222/392)developed hyperoxemia during the ICU.Compared with non-hyperoxemia group,patients in hyperoxemia group in the ICU were younger[years:56(39,71)vs.62(46,72)],had lower body mass index[kg/m^(2):21.5(19.5,23.6)vs.22.5(20.0,25.0)],longer mechanical ventilation times[hours:82.0(43.0,161.0)vs.67.5(37.8,127.0)],and longer length of ICU stay[days:6.0(4.0,11.8)vs.4.0(3.0,8.0)],the proportions of mechanical ventilation,PaO_(2)upon admission to ICU and during the ICU,during the ICU stay and oxygenation index(PaO_(2)/FiO_(2))upon admission to the ICU and during the ICU stay,blood lactic acid(Lac)upon admission to the ICU and the incidence of new infections during the ICU stay were higher in the hyperoxemia group than those in non-hyperoxem
作者
张乾富
刘旭
何德华
刘頔
钟剑敏
唐艳
王迪芬
Zhang Qianfu;Liu Xu;He Dehua;Liu Di;Zhong Jianmin;Tang Yan;Wang Difen(Guizhou Medical University,Guiyang 550004,Guizhou,China;Department of Critical Care Medicine,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China;School of Journalism and Communication,Beijing Normal University,National Digital Health Research Center,China Academy of Education and Social Development,Beijing 100875,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2023年第3期282-286,共5页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
国家重点研发计划(2018YFC2001904)
国家自然科学基金(81960357,81701958)
贵州省科技计划项目(2020-1Y330,2022-370)
吴阶平医学基金会临床科研专项资助基金项目(320.6750.18001)
国家临床重点专科建设项目(2011-170)
贵州省临床重点学科建设项目(2011-52)。
关键词
重症患者
高氧血症
发生率
临床特征
危险因素
Critically ill patient
Hyperoxemia
Incidence
Clinical characteristic
Risk factor
