探寻肺栓塞脉搏血氧饱和度的目标区间

目的探讨肺栓塞患者氧疗期间脉搏血氧饱和度(pulse oxygen saturation, SpO_2)与院内全因死亡风险的关系。方法检索2014—2015年eICU数据库中美国多家医院以肺栓塞为主要诊断的病历资料。以院内全因死亡为因变量,氧疗期间中位SpO_2为自变量构建广义相加模型(generalized additive model, GAM),分析肺栓塞患者氧疗期间中位SpO_2与院内全因死亡率的关系,并绘制曲线图,以曲线最低最平坦区域为SpO_2目标区间。采用多因素Cox回归分析法验证氧疗期间SpO_2水平与肺栓塞患者院内全因死亡风险的关系。结果共入选符合纳入和排除标准的肺栓塞患者422例,其氧疗期间中位SpO_2为97%(95%,98%),院内存活336例(79.6%),全因死亡86例(20.4%)。GAM分析结果显示,氧疗期间中位SpO_2与肺栓塞患者院内全因死亡率呈U形关系,中位SpO_2处于96%～98%时,院内全因死亡率最低。多因素Cox回归分析结果显示,氧疗期间SpO_2水平是肺栓塞患者发生院内全因死亡的独立影响因素,以中位SpO_2处于96%～98%患者为对照,中位SpO_2<96%患者院内全因死亡的风险增加129.8%(HR=2.298,95%CI:1.268～4.163,P=0.006),中位SpO_2>98%患者院内全因死亡风险增加77.3%(HR=1.773, 95%CI:1.068～2.942,P=0.027)。结论肺栓塞患者氧疗期间SpO_2与院内全因死亡风险呈U形关系,氧疗期间SpO_2处于96%～98%时,院内全因死亡风险最低,可能为氧合的目标区间。

The Search for Optimal Pulse Oxygen Saturation Targets in Pulmonary Embolism Patients

Objective To determine the association between pulse oximetry-derived oxygen saturation(SpO_2) and all-cause in-hospital mortality of patients with pulmonary embolism during oxygen therapy. Methods Clinical data of the patients with pulmonary embolism as the primary diagnosis in different American medical institutions from the eICU database during 2014 to 2015 were retrieved. Generalized additive model(GAM) was constructed and the graph was drawn to analyze the association between median SpO_2 and all-cause in-hospital mortality. The lowest and smooth area of the curve was the optimal SpO_2 range. Moreover, the mult-ivariate Cox regression model was applied to verify the association between SpO_2 level during oxygen therapy and all-cause in-hospital mortality of patients with pulmonary embolism. Results A total of 422 patients with pulmonary embolism that met the inclusion and exclusion criteria were enrolled. The median score of SpO_2 was 97%(95%, 98%) during oxygen therapy.A total of 336(79.6%) patients were discharged from the hospital and 86(20.4%) patients died. The GAM indicated a U-shaped relationship between the median score of SpO_2 and all-cause in-hospital mortality in patients with pulmonary embolism. In addition, the lowest mortality was observed when the SpO_2 range was 96%-98%. Multivariable Cox regression analysis confirmed that the SpO_2 level was independently associated with decreased mortality. Taking patients with median SpO_2 rang of 96% to 98% as controls, the risk of all-cause in-hospital mortality was increased by 129.8% in patients with median SpO_2 <96%(HR=2.298, 95% CI:1.268-4.163,P=0.006) and 77.3% in patients with median SpO_2 >98%(HR=1.773, 95% CI: 1.068-2.942, P=0.027). Conclusions The relationship between SpO_2 levels and all-cause in-hospital mortality followed a U-shaped curve in patients with pulmonary embolism. The risk of all-cause in-hospital mortality was lowest when SpO_2 was between 96% to 98% during oxygen therapy, which may be the target range of oxygenation.