基于倾向性评分匹配法探讨严重非腹部创伤患者早期高氧血症与急性胃肠损伤的相关性

A propensity score-matched study of correlation between early hyperoxia and acute gastrointestinal injury in patients with severe non-abdominal trauma

目的:探讨严重非腹部创伤患者入ICU后24 h内高氧血症与急性胃肠损伤(AGI)的相关性。方法:回顾性分析2013年1月—2020年3月期间就诊于南京医科大学附属江宁医院ICU的损伤严重程度评分(ISS)≥16分的严重非腹部创伤患者。根据入ICU 24 h内血气分析获得的动脉血氧分压(PaO_(2))平均值分为两个队列:高氧组[PaO_(2)>120 mmHg(1 mmHg=0.133 kPa)]和常氧组(PaO_(2)=60~120 mmHg)。最终共有404例患者纳入本研究,其中高氧组195例,常氧组209例。收集患者临床资料,通过倾向性评分匹配(PSM)校正患者年龄、性别、APACHEⅡ评分等因素,比较PSM前后高氧组和常氧组之间的临床资料,使用匹配后数据集比较两组患者发生AGI等临床结局的差异。随后采用logistic回归分析404例严重非腹部患者AGI的独立危险因素。结果:高氧组和常氧组PSM前ISS评分、APACHEⅡ评分、机械通气、心率、头/颈部创伤患病率分布不均衡,差异有统计学意义(P<0.05)。经倾向性评分最邻近匹配法(按1∶1匹配),共139对匹配。匹配后高氧组和常氧组在各协变量的差异全部均衡可比,差异无统计学意义(P>0.05)。与常氧组(41.0%)相比,高氧组患者AGI发生率(70.5%)更高(P<0.01),ICU住院时间延长(6 d vs.5 d,P=0.04),均差异有统计学意义。而两组患者住院病死率(29.5%vs.20.9%,P=0.13)及ICU机械通气时间[7.1(4.1~10.3)vs.6.1(4.1~9.2),P=0.22]比较,均差异无统计学意义(P>0.05)。Logistic分析显示年龄较大的患者AGI发生率降低(OR=0.98,95%CI:0.97~0.99,P<0.01),机械通气患者AGI发生率增高(OR=2.34,95%CI:1.34~4.09,P<0.01)。结论:严重非腹部创伤患者早期高氧血症可导致AGI的发生,并延长ICU住院时间。机械通气及年龄较低是AGI发生的独立危险因素。

Objective:To investigate the correlation between early hyperoxia and acute gastrointestinal injury(AGI)in ICU patients with severe non-abdominal trauma.Methods:This was a retrospective analysis conducted in the Affiliated Jiangning Hospital of Nanjing Medical University.Non-abdominal trauma patients was enrolled with Injury Severity Score(ISS)≥16 who admitted to hospital from January 2013 to March 2020.The cohorts were categorized into two groups based on the mean arterial partial pressure of oxygen(PaO)within 24 hours of admission to ICU:hyperoxia and normoxia group[defined as PaO>120 mmHg(1 mmHg=0.133 kPa)and PaO=60-120 mmHg,respectively].A total of 404 patients were finally enrolled,including 195 in the hyperoxia group and 209 in the normoxia group.Propensity score-matching(PSM)was used to assemble a cohort of patients with similar baseline characteristics,including age,gender,APACHEⅡscore,etc.The clinical data of the two groups before and after PSM were compared.The data set after PSM was used for further analysis including incidence of AGI,duration of mechanical ventilation,length of ICU stay and in-hospital mortality.Logistic regression was used to analyse the independent risk factors of AGI in 404 severe non-abdominal patients.Results:Before PSM,ISS score,APACHEⅡscore,incidence of mechanical ventilation,heart rate,and the incidence of head/neck trauma were significantly different between the two groups(P<0.05).A total of 141 pairs were matched in a 1:1 greedy nearest neighbor algorithm.After PSM,the included covariates had a good balance between the hyperoxia group and the normoxia group,and the differences were not statistically significant.Patients in the hyperoxia group had a higher AGI incidence(70.5%vs.41.0%,P<0.01)and length of stay in ICU(6 days vs.5 days,P=0.01).There was no significant difference between the groups with respect to in-hospital mortality[7.1(4.1-10.3)vs 6.1(4.1-9.2),P=0.22]and the duration of mechanical ventilation(29.5%vs.20.9%,P=0.13).Logistic analysis showed that the incidence of AGI was lower in the older age group(OR=0.98,95%CI:0.97-0.99,P<0.01),and was higher in mechanical ventilation group(OR=2.34,95%CI:1.34-4.09,P<0.01).Conclusion:The results of this study suggest a significant association between early hyperoxia and high AGI incidence and prolonged ICU length of stay in patients with severe non-abdominal trauma.Mechanical ventilation and younger age are independent risk factors for AGI.