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探寻肺栓塞脉搏血氧饱和度的目标区间

王洋 陈豪

王洋, 陈豪. 探寻肺栓塞脉搏血氧饱和度的目标区间[J]. 协和医学杂志, 2022, 13(1): 89-95. doi: 10.12290/xhyxzz.2021-0212
引用本文: 王洋, 陈豪. 探寻肺栓塞脉搏血氧饱和度的目标区间[J]. 协和医学杂志, 2022, 13(1): 89-95. doi: 10.12290/xhyxzz.2021-0212
WANG Yang, CHEN Hao. The Search for Optimal Pulse Oxygen Saturation Targets in Pulmonary Embolism Patients[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(1): 89-95. doi: 10.12290/xhyxzz.2021-0212
Citation: WANG Yang, CHEN Hao. The Search for Optimal Pulse Oxygen Saturation Targets in Pulmonary Embolism Patients[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(1): 89-95. doi: 10.12290/xhyxzz.2021-0212

探寻肺栓塞脉搏血氧饱和度的目标区间

doi: 10.12290/xhyxzz.2021-0212
基金项目: 

重庆市卫生健康委医学科研项目 2022WSJK051

详细信息
    通讯作者:

    陈豪, E-mail: 1041863309@qq.com

  • 中图分类号: R563.5

The Search for Optimal Pulse Oxygen Saturation Targets in Pulmonary Embolism Patients

Funds: 

Medical Scientific Research Project of Chongqing Health Commission 2022WSJK051

More Information
  • 摘要:   目的  探讨肺栓塞患者氧疗期间脉搏血氧饱和度(pulse oxygen saturation, SpO2)与院内全因死亡风险的关系。  方法  检索2014—2015年eICU数据库中美国多家医院以肺栓塞为主要诊断的病历资料。以院内全因死亡为因变量,氧疗期间中位SpO2为自变量构建广义相加模型(generalized additive model, GAM),分析肺栓塞患者氧疗期间中位SpO2与院内全因死亡率的关系,并绘制曲线图,以曲线最低最平坦区域为SpO2目标区间。采用多因素Cox回归分析法验证氧疗期间SpO2水平与肺栓塞患者院内全因死亡风险的关系。  结果  共入选符合纳入和排除标准的肺栓塞患者422例,其氧疗期间中位SpO2为97%(95%, 98%),院内存活336例(79.6%),全因死亡86例(20.4%)。GAM分析结果显示,氧疗期间中位SpO2与肺栓塞患者院内全因死亡率呈“U”形关系,中位SpO2处于96%~98%时,院内全因死亡率最低。多因素Cox回归分析结果显示,氧疗期间SpO2水平是肺栓塞患者发生院内全因死亡的独立影响因素,以中位SpO2处于96%~98%患者为对照,中位SpO2<96%患者院内全因死亡的风险增加129.8%(HR=2.298, 95% CI:1.268~4.163, P=0.006),中位SpO2>98%患者院内全因死亡风险增加77.3%(HR=1.773, 95% CI:1.068~2.942, P=0.027)。  结论  肺栓塞患者氧疗期间SpO2与院内全因死亡风险呈“U”形关系,氧疗期间SpO2处于96%~98%时,院内全因死亡风险最低,可能为氧合的目标区间。
    作者贡献:王洋负责数据提取与处理、统计分析、论文撰写及修改;陈豪负责研究项目设计、统计分析及论文修订。
    利益冲突:所有作者均声明不存在利益冲突
  • 图  1  肺栓塞患者氧疗期间中位SpO2与院内全因死亡率的关系图

    SpO2:同表 1;灰色区域表示SpO2的95% CI

    图  2  氧疗期间不同SpO2水平肺栓塞患者Kaplan-Meier生存曲线图

    SpO2:同表 1

    表  1  肺栓塞患者一般临床资料(n=422)

    变量 存活组(n=336) 死亡组(n=86) P
    年龄[M(P25, P75), 岁] 64(51,76) 63(56,74) 0.489
    男性[n(%)] 169(50.3) 48(55.8) 0.361
    氧疗期间SpO2[M(P25, P75), %] 97(96,98) 97(95,99) 0.807
    住院时间[M(P25, P75), d] 9.70(6.14,14.70) 8.44(5.49,13.52) 0.174
    APACHE Ⅳ评分[M(P25, P75), 分] 60(44,82) 82(56,114) <0.001
    sPESI评分[M(P25, P75), 分] 1(0,2) 1(1,2) 0.008
    溶栓治疗[n(%)] 33(9.8) 3(3.5) 0.061
    抗凝治疗[n(%)] 211(62.8) 40(46.5) 0.006
    氧疗方式[n(%)] <0.001
      COT 119(35.4) 12(14.0)
      NIV 51(15.2) 5(5.8)
      IMV 166(49.4) 69(80.2)
    SpO2:脉搏血氧饱和度;APACHE Ⅳ:急性生理学和慢性健康状况评分系统Ⅳ;sPESI:简化肺栓塞风险指数;COT:鼻导管或面罩给氧;NIV:无创机械通气;IMV:有创机械通气
    下载: 导出CSV

    表  2  肺栓塞患者院内全因死亡危险因素的Cox回归分析结果

    变量 单因素Cox回归分析 方差膨胀因子 多因素Cox回归分析
    HR(95% CI) P HR(95% CI) P
    中位SpO2<96%* 1.994(1.129~3.522) 0.017 1.018 2.298(1.268~4.163) 0.006
    中位SpO2>98%* 2.131(1.291~3.517) 0.003 1.018 1.773(1.068~2.942) 0.027
    APACHE Ⅳ评分 1.013(1.007~1.020) 0.000 1.234 1.012(1.005~1.019) 0.001
    sPESI评分 1.410(1.134~1.754) 0.002 1.017 1.280(1.025~1.599) 0.030
    抗凝治疗 0.625(0.408~0.958) 0.031 1.047 0.626(0.405~0.969) 0.035
    NIV# 1.030(0.362~2.929) 0.956 1.274 0.911(0.315~2.636) 0.863
    IMV# 1.927(1.035~3.585) 0.038 1.274 1.347(0.704~2.577) 0.368
    SpO2、APACHE Ⅳ、sPESI、NIV、COT、IMV:同表 1*以中位SpO296%~98%患者为对照,#以COT患者为对照
    下载: 导出CSV
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出版历程
  • 收稿日期:  2021-02-21
  • 录用日期:  2021-05-20
  • 刊出日期:  2022-01-30

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