氧储备指数对危重症患者高氧血症的监测价值

Clinical value of oxygen reserve index for monitoring hyperoxemia in critically ill patients

目的通过探讨危重症患者氧储备指数(oxygen reserve index,ORI)与动脉血氧分压(PaO_(2))之间的关系,评估ORI作为高氧血症监测指标的有效性和预测价值。方法收集本院2019年5月至2021年4月抢救室及EICU遵循《机械通气临床应用指南(2006)》标准进行有创机械通气的危重症患者,依据纳入与排除标准最终统计39例患者,记录基本资料、氧疗条件、静脉氧饱和度(Sp O_(2))及机械通气治疗后的PaO_(2)、动脉二氧化碳分压(PaCO_(2))、血红蛋白(HGB)、氧合指数及其对应的ORI值等。采用Pearson相关系数及线性回归模型分析ORI和PaO_(2)之间的相关性。绘制受试者工作特征(ROC)曲线研究ORI对高氧血症的预测价值及高氧血症对应的ORI临界值。采用多因素线性回归分析ORI监测过程中的影响因素。结果 PaO_(2)与ORI存在正相关性(r=0.479,P <0.05),ORI对Pa O_(2)≥120 mm Hg、Pa O_(2)≥150 mm Hg预测价值的ROC曲线下面积分别为0.718、0.804,差异有统计学意义(P <0.05),ROC曲线临界值分别为0.18(敏感度81.0%,特异度61.1%)、0.26(敏感度85.7%,特异度72.0%)。39例患者中有14例在维持Sp O_(2)≥97%时可下调吸入氧浓度(FiO_(2)),下调后的ORI值0.07±0.08,下调△FiO_(2)值17.7%±10.4%;ORI的监测不受年龄、心率、HGB、平均动脉压、氧合指数的影响,氧疗浓度为独立影响因素。结论危重症患者ORI与PaO_(2)呈正相关关系,一定程度上可以通过监测ORI来预测PaO_(2),通过调整FiO_(2)来避免不必要的高浓度氧疗。

Objective To investigate the effectiveness and predictive value of oxygen reserve index( ORI) as a monitoring indicator to avoid hyperoxemia by discussing the relationship between arterial partial pressure of oxygen( PaO_(2)) and ORI. Methods This study included critically ill patients who received invasive mechanical ventilation in the emergency room and EICU in accordance with the Guidelines for Clinical Application of Mechanical Ventilation( 2006) of our hospital from May 2019 to April 2021. A total of 39 patients were counted according to the inclusion and exclusion criteria. Basic data,oxygen treatment conditions,venous oxygen saturation( SpO_(2)),arterial blood gas analysis after the start of mechanical ventilation,PaO_(2),carbon dioxide partial pressure( PaCO_(2)),hemoglobin( HGB),oxygenation index and the corresponding ORI value were recorded. Pearson correlation coefficient and linear regression model were used to analyze the correlation between ORI and PaO_(2). Receiver operating characteristic( ROC) curves were drawn to study the predictive value of ORI in hyperoxemia and the critical value of ORI. Multivariate linear regression was used to analyze the influencing factors in ORI monitoring process. Results There was a positive correlation between PaO_(2) and ORI( r = 0. 479,P <0. 05). The ROC curve results of the predictive value of ORI for PaO_(2)≥120 mm Hg and PaO_(2)≥150 mm Hg showed that the areas under the ROC curve were 0. 718 and 0. 804 respectively,there was statistical significance( P < 0. 05). The ROC cut-off values were 0. 18( sensitivity 81. 0%,specificity61. 1%) and 0. 26( sensitivity 85. 7%,specificity 72. 0%),respectively. Among the 39 patients,FiO_(2) of 14 patients( SpO_(2)≥97%) was downregulated,and the ORI value after the downregulation was 0. 07 ± 0. 08,and the △FiO_(2) value was( 17. 7 ± 10. 4) % down. The monitoring of ORI was independent of age, heart rate, HGB, mean arterial pressure and oxygenation index. Oxygen concentration was an independent influencing factor. Conclusions There is a positive correlation between ORI and PaO_(2) in critically ill patients. To some extent,the detection of ORI can predict PaO_(2),and the adjustment of FiO_(2) can avoid unnecessary high-concentration oxygen therapy.