实用医学杂志 ›› 2021, Vol. 37 ›› Issue (7): 914-918.doi: 10.3969/j.issn.1006⁃5725.2021.07.017

• 临床研究 • 上一篇    下一篇

非心脏术后低氧性呼衰患者经鼻高流量氧疗失败危险因素及早期预警模型

杜安琪, 李纾, 吕姗 ,赵连泽, 安友仲    

  1. 北京大学人民医院重症医学科(北京 100044)

  • 出版日期:2021-04-10 发布日期:2021-04-10
  • 通讯作者: 安友仲 E⁃mail:bjicu@163.com
  • 基金资助:
    首都卫生发展科研专项资助项目(编号:首发 2016⁃4⁃4084)

Analysis of risk factors associated with failure of nasal high ⁃ flow oxygen therapy in hypoxic respiratory failure patients after non⁃cardiac surgery

DU Anqi,LI Shu,LV Shan,ZHAO Lianze,AN Youzhong   

  1. Depart⁃ ment of Critical Care Medicine,Peking University People′s Hospital,Beijing 100044,China

  • Online:2021-04-10 Published:2021-04-10
  • Contact: AN Youzhong E⁃mail:bjicu@163.com

摘要:

目的 分析非心脏术后低氧性呼衰患者接受经鼻高流量氧疗(HFNC)治疗失败的早期危 险因素。方法 回顾分析北京大学人民医院 2016 1 月至 2019 12 月接受 HFNC 治疗并符合标准的患者资料,探索HFNC 失败的心脏及非心脏危险因素并建立早期预警模型。结果 共纳入患者 133 例, 根据 HFNC 失败标准分为 HFNC 失败组(n = 40)和成功组(n = 93)。多因素分析显示,治疗初期高急性 生理与慢性健康状况评分Ⅱ(APACHⅡ)、发热、高心肌肌钙蛋白 I(TNI)及治疗 1 h ROX(SpO2/FiO2/ RR)< 8是HFNC失败的独立危险因素;建立回归模型Y = -2.158+1.882 × 发热+0.283 × APACHII⁃0.326 × ROX+ 2.222 × TNI,模型 ROC 曲线下面积(AUC)为 0.915。结论 非心脏术后低氧性呼衰患者应用 HFNC,基础高 APACHⅡ评分及 TNI、发热,提示治疗失败风险较高,应谨慎选择,治疗 1 h ROX 仍较低,应及时调整治疗策略。

关键词:

Abstract:

Objective To investigate the risk factors associated with failure of nasal high⁃flow nasal oxy⁃ gen therapy(HFNC)in hypoxic respiratory failure patients after non⁃cardiac surgery. Methods This retrospective study was conducted at Peking University People′s Hospital. The subjects included all patients who suffering hypoxic respiratory failure after non⁃cardiac surgery from January 2016 to December 2019. Clinical and laboratory parame⁃ ters use statistical methods to explore the risk factors involved in HFNC failure and establish an early warning model. Results A total of 133 patients were included. According to HFNC failure criteria,patients were divided into HFNC failure group(n = 40)and success group(n = 93). Multivariate analysis showed that patient with temperature (T)> 37.3 ℃,high acute physiology and chronic health status score Ⅱ(APACHⅡ)score,cardiac troponinⅠ (TNI )level before using HFNC,and low ROX(SpO2/FiO2/RR)< 8 at 1 hour after treatment were independent risk factors for HFNC failure;a regression model was established:Y = -2.158 + 1.882 × fever + 0.283 × APACHⅡ- 0.326 × ROX + 2.222 × TNI,the area under the ROC curve(AUC)of the model is 0.915(P < 0.01). Conclusions Hypoxic respiratory failure patients after non⁃cardiac surgery fever,High APACHII score and TNI level at baseline are indicate a higher risk of HFNC failure. ROX is still lower after 1 h treatment an important indicator for further mechanical ventilation,the treatment strategy should be adjusted in time.

Key words:

High?flow nasal cannula oxygen therapy, non?cardiac surgery, hypoxic respiratory failure, failure, risk factors