超生理性动脉血氧水平与危重病人死亡率的关系:一项多中心观察性队列研究
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The Association Between Supra-Physiologic Arterial Oxygen Levels and Mortality in Critically Ill Patients: A Multi-Centre Observational Cohort Study
背景与目的
目前研究报道危重病人暴露于超生理性动脉血氧(高氧血症)的危害存在相互矛盾的证据。回顾性分析2014年1月31日至2018年12月31日美国国家卫生研究院重症监护卫生信息学协作中心(CC-HIC)收治的ICU患者（5所英国大学医院重症监护病房(ICUs)研究患者高氧血症的纵向暴露与死亡率之间的关系）。
方 法
对0-1、0-3、0-5和0-7天氧暴露窗口的亚组进行评估，分别捕获19515、10525、6360和4296例患者。高氧血症剂量定义为PaO2时间曲线与13.3 kPa (100 mmHg)的边界之间的面积除以潜在暴露时间(24、72、120或168小时)。
结 果
高氧血症暴露与ICU死亡率之间存在相关性[优势比(95%CI:1.15 0.95-1.38)， p = 0.15;1.35(1.04-1.74)， p = 0.02;1.5(1.07-2.13)， p = 0.02;和1.74(1.11-2.72)，0-1、0-3、0-5、0-7天的暴露窗口分别为p = 0.02。然而，剂量-反应关系未被观察到。高氧血症与呼吸系统并发症或机械通气之间的无明显差异。
结 论
本研究发现高氧血症和死亡率之间存在一定程度的相关性，但仍需要进一步的实验研究探索这个问题。
原始文献摘要
The Association Between Supra-Physiologic Arterial Oxygen Levels and Mortality in Critically Ill Patients: A Multi-Centre Observational Cohort Study.Am J Respir Crit Care Med.2019.9(12):1-54 .doi: 10.1164/rccm.201904-0849OC.
Background：There is conflicting evidence on harm related to exposure to supra-physiologic arterial oxygen tensions (hyperoxemia) in critically ill patients.
Objectives：To examine the association between longitudinal exposure to hyperoxemia and mortality in patients admitted to intensive care units (ICUs) in 5 UK University Hospitals.Methods Retrospective cohort of ICU admissions between 31st January 2014 - 31st December 2018,from the National Institute of Health Research Critical Care Health Informatics Collaborative (CC-HIC). Multivariable logistic regression modelled death in ICU by exposure to hyperoxemia.
Measurements：Subsets with oxygen exposure windows of 0-1, 0-3, 0-5 and 0-7 days were evaluated,capturing 19,515, 10,525, 6,360 and 4,296 patients, respectively.Hyperoxemia dose was defined as the area between the PaO2 time curve and a boundary of 13.3 kPa (100 mmHg) divided by the hours of potential exposure (24, 72, 120, or 168 hours).
Main Results：An association was found between exposure to hyperoxemia and ICU mortality [odds ratios(95% compatibility intervals); 1.15 (0.95-1.38), p = 0.15; 1.35(1.04-1.74), p = 0.02; 1.5(1.07-2.13), p = 0.02; and 1.74 (1.11-2.72), p = 0.02 for exposure windows of 0-1, 0-3, 0-5 and 0-7 days’ duration, respectively. However, a dose-response relationship was not observed. There was no evidence to support a differential effect between hyperoxemia and either a respiratory diagnosis or mechanical ventilation.
Conclusions：An association between hyperoxemia and mortality was observed in our large, unselected multicenter cohort. The absence of a dose-response relationship weakens causal interpretation. Further experimental research is warranted to elucidate this important question.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：王丹阳 陈鹏（吉林大学中日联谊医院麻醉科 ）
编辑：何幼芹 审校：王贵龙