血气分析指标变化对普通型COVID-19患者病程分期的鉴别价值

Differential value of blood gas analysis indicator changes in disease course staging of moderate COVID-19 patients

目的探讨普通型新型冠状病毒肺炎(COVID-19)患者住院过程中血气分析指标的变化情况及其临床意义。方法收集2020年1-3月长春市传染病医院电子病历系统中24例普通型COVID-19患者临床资料和多次血气分析结果。根据患者住院时间将病程分为发病初期、急性期和转阴期,分析不同病程分期普通型COVID-19患者血气分析指标的变化情况,采用受试者工作特征(ROC)曲线下面积(AUC)评价差异有统计学意义的指标在病程分期中的鉴别效能。结果乳酸(Lac)、实际碳酸氢盐、二氧化碳总含量(TCO_(2))水平在发病初期与急性期间差异有统计学意义(P<0.05);动脉血氧分压(PaO_(2))、Lac、TCO_(2)水平在急性期与转阴期间差异有统计学意义(P<0.05);PaO_(2)、细胞外液碱剩余、TCO_(2)水平在发病初期与转阴期间差异有统计学意义(P<0.05)。ROC曲线分析结果显示,Lac鉴别发病初期与急性期、急性期与转阴期的AUC最大,分别为0.869(95%CI:0.769~0.969,P<0.001)、0.791(95%CI:0.665~0.916,P<0.001);TCO_(2)鉴别发病初期与转阴期的AUC最大,为0.804(95%CI:0.674~0.934,P<0.001)。结论血气分析指标变化对普通型COVID-19患者病程分期鉴别与治疗具有重要意义。

Objective To investigate the changes and clinical significance of blood gas analysis indicators in patients with moderate Coronavirus disease(COVID-19)during hospitalization.Methods The clinical data and multiple blood gas analysis results of 24 patients with moderate COVID-19 in the electronic medical record system of Changchun Infectious Diseases Hospital from January to March 2020 were collected.The disease course was divided into the initial stage,the acute stage and the negative stage according to the hospitalization time of patients.The changes of blood gas analysis indicators in patients with moderate COVID-19 in different disease course stages were analyzed,and the area under the receiver operating characteristic(ROC)curve(AUC)was used to evaluate the discriminating efficacy of the indicators with statistically significant differences in disease course stages.Results There were statistically significant differences in the levels of lactic acid(Lac),actual bicarbonate and total carbon dioxide(TCO_(2))between the initial stage and the acute stage(P<0.05);there were statistically significant differences in the levels of arterial partial pressure of oxygen(PaO_(2)),Lac and TCO_(2) between the acute stage and the negative stage(P<0.05);there were statistically significant differences in the levels of PaO_(2),extracellular fluid base excess and TCO_(2) between the initial stage and the negative stage(P<0.05).The ROC curve analysis results showed that the AUC of Lac in differentiating the initial stage and the acute stage,the acute stage and the negative conversion stage was the largest,which were 0.869(95%CI:0.769-0.969,P<0.001),0.791(95%CI:0.665-0.916,P<0.001),respectively;the AUC of TCO_(2) in differentiating the initial stage and the negative stage was the largest,which was 0.804(95%CI:0.674-0.934,P<0.001).Conclusion The changes of blood gas analysis indicators in patients with moderate COVID-19 are of great significance to disease course staging and treatment.