氧合指数及弥散指数对新型冠状病毒肺炎合并急性呼吸窘迫综合征的机械通气患者预后的评估研究

Evaluation of Prognosis of Novel Coronavirus Pneumonia Combined with Acute Respiratory Distress Syndrome Patients with the Oxygenation Index and Dispersion Index of Mechanical Ventilation

背景《新型冠状病毒肺炎诊疗方案(试行第七版)》指出若重症、危重症患者的治疗中使用高流量鼻导管氧疗或无创通气后短时间(1~2 h)内病情无改善甚至恶化,应当及时进行气管插管和有创机械通气,但其并未给出客观参考指标,而通常使用的氧合指数在该类患者临床应用中存在不足,故而探寻更有参考价值的预后评估指标显得尤为重要。目的分析新型冠状病毒肺炎(COVID-19)患者出现急性呼吸窘迫综合征(ARDS)进行机械通气治疗时氧合指数和弥散指数对患者预后评估的差异。方法选取2020-01-25至03-14在武汉科技大学天佑医院ICU收治的行机械通气的COVID-19并发ARDS患者39例,其中2例因24 h内死亡脱失,以患者28 d的预后结果分为生存组(n=11)和死亡组(n=26),记录呼吸机参数设置与对应的血气数值,分析氧合指数、弥散指数与患者28 d预后的相关性。结果生存组最差氧合指数、入ICU时弥散指数、最差弥散指数高于死亡组(P<0.05)。入ICU时氧合指数预测死亡的灵敏度为100.0%,特异度为46.2%,ROC曲线下面积(AUC)为0.654,AUC与参考值比较,差异无统计学意义(P=0.144);最差氧合指数预测死亡的灵敏度为3.8%,特异度为100.0%,AUC为0.862,AUC与参考值比较,差异有统计学意义(P<0.05);入ICU时弥散指数预测死亡的灵敏度为7.7%,特异度为100.0%,AUC为0.734,AUC与参考值比较,差异有统计学意义(P<0.05);最差弥散指数预测死亡的灵敏度为100.0%,特异度为80.8%,AUC为0.902,AUC与参考值比较,差异有统计学意义(P<0.05)。结论对于COVID-19患者发生ARDS时,弥散指数是比氧合指数灵敏度高且可信度高的预后评估指标。

Backgroud In the treatment of severe and severe cases,New Coronavirus pneumonia diagnosis and treatment plan(Trial Seventh Edition)suggested that if the patients did not improve or deteriorate within a short time(1-2 h)after the use of high flow nasal catheter oxygen therapy or non-invasive ventilation,tracheal intubation and invasive mechanical ventilation should be carried out in time.No objective reference indexes have been proposed in the opinions,and the commonly used oxygenation index is insufficient in the clinical application of such patients,so it is particularly important to explore more valuable reference indexes.Objective To compare the difference of dispersion index and oxygenation index in the prognosis assessment of patients diagnosed with Novel Coronavirus Pneumonia(COVID-19)who have acute respiratory distress syndrome(ARDS)when they are treated with mechanical ventilation.Methods A retrospective single center study was conducted in 39 patients with ARDS of Novel Coronavirus Pneumonia admitted to ICU with mechanical ventilation of Wuhan Tianyou Hospital from January 25,2020 to March 14,2020.Two of them were lost due to death within 24 hours,patients were divided into survival group(n=11)and death group(n=26)according to their 28-day status.Ventilator parameters and corresponding blood gas values were recorded to study the correlation between dispersion index and oxygenation index and 28 days'prognosis of patients.Results The worst oxygenation index,the dispersion index,and the worst dispersion index when entering ICU in the survival group were higher than those in the death group(P<0.05).The sensitivity of the oxygenation index to predict death when entering the ICU was 100.0%,the specificity of the oxygenation index was 46.2%,the area under the ROC curve(AUC)was 0.654,and the difference between AUC and the reference value was not statistically significant(P=0.144);The sensitivity of the oxygenation index to predict death was 3.8%,the specificity was 100.0%,and the AUC was 0.862 when the oxygenation index was the lowest,comparing with the reference value,the difference was statistically significant(P<0.05);The sensitivity of the dispersion index to predict death was 7.7%,the specificity was 100.0%,and the AUC was 0.734 when entering the ICU,comparing with the reference value,the difference was statistically significant(P<0.05);The sensitivity of the dispersion index to predict death was 100.0%,the specificity was 80.8%,and the AUC was 0.902 when the dispersion index was the lowest,comparing with the reference value,the difference was statistically significant(P<0.05).Conclusion Dispersion index is a more sensitive and reliable prognostic indicator for ARDS in Novel Coronavirus Pneumonia patients than oxygenation index.The dispersion index is a more sensitive and reliable prognostic evaluation index than the oxygenation index in Novel Coronavirus Pneumonia patients with ARDS.