早期预测经鼻高流量湿化氧疗治疗结局的指标

Early predictors of high flow nasal cannula therapy outcomes

目的:探索早期预测经鼻高流量湿化氧疗(HFNC)治疗非肺炎所致急性低氧性呼吸衰竭(AHRF)结局的指标,并探讨其预测患者结局的价值。方法:本研究为回顾性队列研究,选取2019年1月至2022年12月江汉大学附属湖北省第三人民医院呼吸与危重症医学科收治的80例采用HFNC治疗的非肺炎所致的AHRF患者,男48例,女32例,年龄(64.13±11.23)岁,年龄范围为37~87岁。根据HFNC治疗是否成功分为成功组( n=50)与失败组( n=30),比较两组患者的一般资料、基线呼吸生理参数、急性生理与慢性健康(APACHE Ⅱ)评分、序贯性器官功能衰竭(SOFA)评分、呼吸速率氧合(ROX)指数、一项包含心率、酸中毒、意识、氧合和呼吸频率组成的综合评分(简称HACOR评分)之间的差异,同时比较治疗2、12、24 h后的ROX指数、HACOR评分。建立HFNC治疗的多因素回归分析模型,并评估其危险因素预测HFNC结局的价值。 结果:成功组患者基线心率[(103.26±9.07)次/分]、呼吸频率[(28.54±2.97)次/分]低于失败组[(109.63±10.60)次/分、(31.83±4.22)次/分],氧合指数(153.73±26.46)高于失败组(139.53±27.34);成功组基线APACHEⅡ评分[(14.24±3.17)分]、SOFA评分[(4.42±1.50)分]、HACOR评分[(5.87±1.34)分]低于失败组[(16.53±2.92)分、(5.63±1.40)分、(7.52±1.35)分],ROX指数(6.65±0.86)高于失败组(5.78±1.04),差异有统计学意义( P<0.05)。多因素分析显示,氧合指数升高是影响HFNC治疗结局的保护因素,APACHEⅡ评分、SOFA评分、HACOR评分升高是影响HFNC治疗结局的危险因素。治疗2、12、24 h后,成功组ROX指数[(7.07±1.13)、(7.16±1.52)、(8.75±2.15)]高于失败组[(6.56±0.96)、(6.24±1.28)、(6.96±2.16)],HACOR评分[(5.46±0.95)分、(3.99±1.63)分、(4.77±1.00)分]低于失败组[(6.81±1.78)分、(6.16±2.06)分、(6.56±1.44 )分],差异有统计学意义( P<0.05)。HACOR评分及ROX指数均在治疗2 h后预测价值最低,但在治疗12、24 h后预测价值逐渐升高。 结论:HFNC治疗具有一定的失败率,在初始考虑是否选择HFNC治疗时,可参考预测模型选择氧合指数、APACHEⅡ评分、SOFA评分、HACOR评分等指标综合判断。在HFNC治疗过程中,ROX指数及HACOR评分预测其结局具有一定的价值,且随时间延长,价值升高。

ObjectiveTo explore the early predictors of high flow nasal cannula(HFNC)therapy outcomes in non-pneumonia induced acute hypoxemic respiratory failure(AHRF),and their values in predicting the outcomes.MethodsThis study was a retrospective cohort study,a total of 80 patients with non-pneumonic-induced AHRF treated with HFNC were selected from the department of Respiratory and Critical Care Medicine in the Hubei NO.3 People′s Hospital of Jianghan University from January 2019 to December 2022,including 48 males and 32 females,aged(64.13±11.23)years old,ranging from 37 to 87 years old.Patients were divided into two groups according to success or failure of HFNC,namely the success group(n=50)and the failure group(n=30).General datas and the baseline respiratory physiological parameters,acute physiology and chronic health evaluation(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,respiratory rate oxygenation(ROX)index,A composite score of heart rate,acidosis,consciousness,oxygenation,and respiratory rate(HACOR score)between the two groups were compared.The ROX index and HACOR score at 2,12 and 24 hours were also compared.The multivariate regression analysis model of HFNC treatment was established,and the value of risk factors in predicting the outcome of HFNC were evaluated.ResultsIn the success group,the baseline heart rate[(103.26±9.07)times/min]and respiratory rate[(28.54±2.97)times/min]were lower than the failure group[(109.63±10.60)times/min,(31.83±4.22)times/min],the oxygenation index(153.73±26.46)was higher than the failure group(139.53±27.34),the baseline APACHEⅡscore[(14.24±3.17)points],SOFA score[(4.42±1.50)points],HACOR score[(5.87±1.34)points]were lower than the failure group[(16.53±2.92)points,(5.63±1.40)points,(7.52±1.35)points],ROX index(6.65±0.86)was higher than the failure group(5.78±1.04),and the differences were statistically significant(P<0.05).Multivariate analyses showed that among the factors affecting the outcome of HFNC treatment,the increase of oxygenation index was the protective factor,and the increase of APACHEⅡscore,SOFA score,and HACOR score were the risk factors.After 2,12 and 24 hours of treatment,in the success group,the ROX indexes[(7.07±1.13),(7.16±1.52),(8.75±2.15)]were higher than the failure group[(6.56±0.96),(6.24±1.28),(6.96±2.16)],the HACOR scores[(5.46±0.95)points,(3.99±1.63)points,(4.77±1.00)points]were lower the failure group[(6.81±1.78)points,(6.16±2.06)points,(6.56±1.44)points],and the differences were statistically significant(P<0.05).The predictive values of HACOR score and ROX index were the lowest at 2 hours,but gradually increased at 12 and 24 hours after treatment.ConclusionsHFNC treatment has a certain failure rate.When initially considering whether to choose HFNC treatment,oxygenation index,APACHEⅡscore,SOFA score,HACOR score can be selected for comprehensive judgment according to the prediction model.In the process of HFNC treatment,the ROX index and HACOR score have certain values in predicting the outcomes,and the values increase with time.