以SpO_2替代PaO_2评估急性呼吸窘迫综合征机械通气患者脱机指征的可行性分析
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摘要
目的探讨以指脉搏氧饱和度(SpO_2)替代动脉血氧分压(PaO_2)即比较SpO_2/吸入氧浓度(FiO_2)×呼气末正压(PEEP)与氧合指数,用于急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)机械通气患者脱机时机评估的可行性。方法回顾性分析2013年7月—2014年7月北京协和医院急诊科抢救室与重症监护病房收治的ARDS机械通气患者110例,均记录呼吸机设置参数与其对应的血气分析结果,依据入院后30 d内患者是否成功脱机分为脱机成功组及脱机失败组。绘制SpO_2/FiO_2×PEEP变化趋势点线图及相关受试者工作特征(ROC)曲线,分析SpO_2/FiO_2×PEEP对于ARDS机械通气患者脱机时机的预测价值。结果入院30 d,成功脱机46例,脱机失败64例,两组SpO_2/FiO_2×PEEP与PaO_2/FiO_2×PEEP的变化趋势有一致性。SpO_2/FiO_2×PEEP与成功脱机相关的ROC曲线下面积为0.829,最佳截断值为241.548,95%CI:0.774,0.884;氧合指数与成功脱机相关的ROC曲线下面积为0.817,最佳截断值为214.65,95%CI:0.760,0.875,且P<0.01。结论 SpO_2/FiO_2×PEEP可用于循环功能较为稳定的ARDS机械通气患者脱机时机的判断。
Objective To investigate feasibility of replacing arterial oxygen tension( PaO_2) with pulse oxygen saturation( SpO_2),which meant to compare SpO_2/fractional concentration of inspired oxygen( FiO_2) × positive and expiratory pressure( PEEP) value with oxygenation index in application of evaluating ventilator weaning for acute respiratory distress syndrome( ARDS) patients with mechanical ventilation. Methods Clinical data of 110 ARDS patients with mechanical ventilation admitted during July 2013 and July 2014 was retrospectively analyzed,and ventilator parameter settings and corresponding results of blood gas analysis were recorded. The patients were divided into successful off-line group and failure off-line group according to whether or not successful ventilator weaning within 30 days after admission. Dotted line table for SpO_2/FiO_2×PEEP changes and related receiver operating curve( ROC) were drawn. Value of SpO_2/FiO_2× PEEP in prediction of off-line appropriate time for ARDS patients with mechanical ventilation was analyzed. Results Within 30 days after admission,there were 46 patients with successful and 64 patients with failure ventilator weaning,and change tendency of SpO_2/FiO_2× PEEP showed consistency with PaO_2/FiO_2× PEEP. ROC area under curve( AUC) of SpO_2/FiO_2× PEEP,which related to off-line,was 0. 829; the best cutoff value was 241. 548; 95% CI was 0. 774,0. 884. ROC AUC of oxygenation index,which related to off-line,was 0. 817; the best cutoff value was 214. 65; 95% CI was 0. 760,0. 875( P < 0. 01). Conclusion SpO_2/FiO_2×PEEP can be used to judge off-line appropriate time of ARDS patients with mechanical ventilation during stable circulation function period.
Objective To investigate feasibility of replacing arterial oxygen tension( PaO_2) with pulse oxygen saturation( SpO_2),which meant to compare SpO_2/fractional concentration of inspired oxygen( FiO_2) × positive and expiratory pressure( PEEP) value with oxygenation index in application of evaluating ventilator weaning for acute respiratory distress syndrome( ARDS) patients with mechanical ventilation. Methods Clinical data of 110 ARDS patients with mechanical ventilation admitted during July 2013 and July 2014 was retrospectively analyzed,and ventilator parameter settings and corresponding results of blood gas analysis were recorded. The patients were divided into successful off-line group and failure off-line group according to whether or not successful ventilator weaning within 30 days after admission. Dotted line table for SpO_2/FiO_2×PEEP changes and related receiver operating curve( ROC) were drawn. Value of SpO_2/FiO_2× PEEP in prediction of off-line appropriate time for ARDS patients with mechanical ventilation was analyzed. Results Within 30 days after admission,there were 46 patients with successful and 64 patients with failure ventilator weaning,and change tendency of SpO_2/FiO_2× PEEP showed consistency with PaO_2/FiO_2× PEEP. ROC area under curve( AUC) of SpO_2/FiO_2× PEEP,which related to off-line,was 0. 829; the best cutoff value was 241. 548; 95% CI was 0. 774,0. 884. ROC AUC of oxygenation index,which related to off-line,was 0. 817; the best cutoff value was 214. 65; 95% CI was 0. 760,0. 875( P < 0. 01). Conclusion SpO_2/FiO_2×PEEP can be used to judge off-line appropriate time of ARDS patients with mechanical ventilation during stable circulation function period.
引文
[1]毛梅,徐剑铖.急性肺损伤/急性呼吸窘迫综合征的治疗进展[J].华南国防医学杂志,2010,24(6):505-507.
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[8]徐军,刘业成,朱华栋,等.Fi O_2×PEEP对重症甲型H1N1流感致急性肺损伤病情评估与预后价值研究[J].中国急救医学,2010,30(2):115-117.
[9]Allardet-Servent J,Forel J M,Roch A,et al.Fi O2and acute respiratory distress syndrome definition during lung protective ventilation[J].Crit Care Med,2009,37(1):202-207.
[10]于荣国,石松菁.ICU诊疗精要[M].2版.北京:中国科学技术出版社,2017:32.
[11]滕丽华,谢志毅,徐军,等.“弥散指数”对急性呼吸窘迫综合征预后评估的研究[J].中华急诊医学杂志,2016,25(9):1154-1158.
[12]O'Driscoll B R,Howard L S,Davison A G,et al.BTS guideline for emergency oxygen use in adult patients[J].Thorax,2008,63(Suppl 6):61-68.
[13]Brower R G,Matthay M A,Morris A,et al.Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome[J].N Engl J Med,2000,342(18):1301-1308.
[14]Villar J,Perez-Mendez L,Blanco J,et al.A universal definition of ARDS:the Pa O2/Fi O2ratio under a standard ventilatory setting—a prospective,multicenter validation stud[J].Intensive Care Med,2013,39(4):583-592.
[15]Brown S M,Grissom C K,Moss M,et al.Nonlinear Imputation of Pa O2/Fi O2From Sp O2/Fi O2Among Patients With Acute Respiratory Distress Syndrome[J].Chest,2016,50(2):307-313.
[16]Bass C M,Sajed D R,Adedipe A A,et al.Pulmonary ultrasound and pulse oximetry versus chest radiography and arterial blood gas analysis for the diagnosis of acute respiratory distress syndrome:a pilot study[J].Crit Care,2015,19:282.
[17]Festic E,Bansal V,Kor D J,et al.Sp O2/Fi O2ratio on hospital admission is an indicator of early acute respiratory distress syndrome development among patients at risk[J].J Intensive Care Med,2015,30(4):209-216.
[18]Wilinska M,Bachman T,Swietlinski J,et al.Automated Fi O2-Sp O2control system in neonates requiring respiratory support:a comparison of a standard to a narrow Sp O2control range[J].BMC Pediatr,2014,14:130.
[19]Sendagire C,Lipnick M S,Kizito S,et al.Feasibility of the modified sequential organ function assessment score in a resource-constrained setting:a prospective observational study[J].BMC Anesthesiol,2017,17(1):12.
[20]姚永明.急危重症病理生理学[M].北京:科学出版社,2013:703.
[2]Johnson E R,Matthay M A.Acute lung injury:epidemiology,pathogenesis,and treatment[J].J Aerosol Med Pulm Drug Deliv,2010,23(4):234-252.
[3]姚泰.生理学[M].5版.北京:人民卫生出版社,2001:155-158.
[4]Schmidt M F,Gernand J,Kakarala R.The use of the pulse oximetric saturation to fraction of inspired oxygen ratio in an automated acute respiratory distress syndrome screening tool[J].J Crit Care,2015,30(3):486-490.
[5]Bilan N,Dastranji A,Ghalehgolab Behbahani A.Comparison of the sp O2/fi O2ratio and the pa O2/fi O2ratio in patients with acute lung injury or acute respiratory distress syndrome[J].J Cardiovasc Thorac Res,2015,7(1):28-31.
[6]杜斌.急性呼吸窘迫综合征的柏林定义:究竟改变了什么?[J].首都医科大学学报,2013,36(2):201-203.
[7]姚永明.急危重症病理生理学[M].北京:科学出版社,2013:650.
[8]徐军,刘业成,朱华栋,等.Fi O_2×PEEP对重症甲型H1N1流感致急性肺损伤病情评估与预后价值研究[J].中国急救医学,2010,30(2):115-117.
[9]Allardet-Servent J,Forel J M,Roch A,et al.Fi O2and acute respiratory distress syndrome definition during lung protective ventilation[J].Crit Care Med,2009,37(1):202-207.
[10]于荣国,石松菁.ICU诊疗精要[M].2版.北京:中国科学技术出版社,2017:32.
[11]滕丽华,谢志毅,徐军,等.“弥散指数”对急性呼吸窘迫综合征预后评估的研究[J].中华急诊医学杂志,2016,25(9):1154-1158.
[12]O'Driscoll B R,Howard L S,Davison A G,et al.BTS guideline for emergency oxygen use in adult patients[J].Thorax,2008,63(Suppl 6):61-68.
[13]Brower R G,Matthay M A,Morris A,et al.Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome[J].N Engl J Med,2000,342(18):1301-1308.
[14]Villar J,Perez-Mendez L,Blanco J,et al.A universal definition of ARDS:the Pa O2/Fi O2ratio under a standard ventilatory setting—a prospective,multicenter validation stud[J].Intensive Care Med,2013,39(4):583-592.
[15]Brown S M,Grissom C K,Moss M,et al.Nonlinear Imputation of Pa O2/Fi O2From Sp O2/Fi O2Among Patients With Acute Respiratory Distress Syndrome[J].Chest,2016,50(2):307-313.
[16]Bass C M,Sajed D R,Adedipe A A,et al.Pulmonary ultrasound and pulse oximetry versus chest radiography and arterial blood gas analysis for the diagnosis of acute respiratory distress syndrome:a pilot study[J].Crit Care,2015,19:282.
[17]Festic E,Bansal V,Kor D J,et al.Sp O2/Fi O2ratio on hospital admission is an indicator of early acute respiratory distress syndrome development among patients at risk[J].J Intensive Care Med,2015,30(4):209-216.
[18]Wilinska M,Bachman T,Swietlinski J,et al.Automated Fi O2-Sp O2control system in neonates requiring respiratory support:a comparison of a standard to a narrow Sp O2control range[J].BMC Pediatr,2014,14:130.
[19]Sendagire C,Lipnick M S,Kizito S,et al.Feasibility of the modified sequential organ function assessment score in a resource-constrained setting:a prospective observational study[J].BMC Anesthesiol,2017,17(1):12.
[20]姚永明.急危重症病理生理学[M].北京:科学出版社,2013:703.