Yang Wenna, Zhang Lin
Department of Critical Care, Hefei First People's Hospital, Hefei 230000, Anhui, China. Corresponding author: Zhang Lin, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Sep;33(9):1069-1073. doi: 10.3760/cma.j.cn121430-20210617-00902.
To compare the effects of conservative oxygen therapy and conventional oxygen therapy on the efficacy and prognosis of mechanical ventilation support in patients with severe pneumonia.
A prospective randomized controlled study were conducted, 110 patients with severe pneumonia requiring mechanical ventilation in intensive care unit (ICU) of Hefei First People's Hospital from May 2019 to May 2021 were selected and divided into conventional oxygen therapy group (51 cases) and conservative oxygen therapy group (55 cases) according to random number table method. Patients in both groups were treated with invasive to non-invasive sequential mechanical ventilation strategy, and the target of oxygen therapy in the conventional oxygen therapy group was set as the arterial partial pressure of oxygen (PaO) > 150 mmHg (1 mmHg = 0.133 kPa) or pulse oxygen saturation (SpO) > 0.96. In the conservative oxygen therapy group, PaO was set at 70-100 mmHg or SpO at 0.90-0.92. The changes of blood gas analysis, mechanical ventilation time, ICU stay time, ICU mortality, new organ dysfunction and infection more than 48 hours after admission were observed in two groups before and after treatment. Kaplan-Meier method was used to analyze the difference in cumulative survival rate between the two groups.
After treatment, pH value, PaO and oxygenation index (PaO/FiO) in both groups were significantly higher than before treatment, and arterial partial pressure of carbon dioxide (PaCO) was significantly lower than before treatment. pH value in the conservative oxygen therapy group was significantly higher than that in the conventional oxygen therapy group (7.4±0.1 vs. 7.3±0.3). PaO, PaCO and PaO/FiO were significantly lower than those in conventional oxygen therapy group [PaO (mmHg): 68.9±4.7 vs. 75.2±6.0, PaCO (mmHg): 42.1±5.6 vs. 50.5±7.5, PaO/FiO (mmHg): 329±126 vs. 365±108, all P < 0.05]. The mechanical ventilation time in the conservative oxygen therapy group was significantly longer than that in the conventional oxygen therapy group (days: 19.7±3.5 vs. 13.9±4.5, P < 0.05), but there was no significant difference in ICU hospitalization time between the conservative oxygen therapy group and the conventional oxygen therapy group (days: 26.5±5.0 vs. 25.5±4.6, P > 0.05). Compared with the conventional oxygen therapy group, the ICU mortality, the incidence of nosocomial bloodstream infection, and the incidence of liver insufficiency, shock, and ICU acquired weakness (ICUAW) were decreased significantly in the conservative oxygen therapy group [ICU mortality: 27.3% (15/55) vs. 45.1% (23/51), liver insufficiency: 1.8% (1/55) vs. 7.8% (4/51), shock: 3.6% (2/55) vs. 9.8% (5/51), ICUAW: 5.5% (3/55) vs. 11.8% (6/51), the incidence of new bloodstream infection: 5.5% (3/55) vs. 11.8% (6/51), all P < 0.05]. Kaplan-Meier analysis showed that the cumulative survival rate of the conservative oxygen therapy group was significantly higher than that of the conventional oxygen therapy group (72.7% vs. 54.9%; Log-Rank test: χ = 4.244, P = 0.039).
Conservative oxygen therapy can reduce ICU mortality, the incidence of shock, liver insufficiency, ICUAW, and bloodstream infection in patients with severe pneumonia, but prolong mechanical ventilation time.
比较保守氧疗与传统氧疗对重症肺炎患者机械通气支持疗效及预后的影响。
进行一项前瞻性随机对照研究，选取2019年5月至2021年5月在合肥市第一人民医院重症监护病房（ICU）需要机械通气的110例重症肺炎患者，根据随机数字表法分为传统氧疗组（51例）和保守氧疗组（55例）。两组患者均采用有创-无创序贯机械通气策略，传统氧疗组的氧疗目标设定为动脉血氧分压（PaO）>150 mmHg（1 mmHg = 0.133 kPa）或脉搏血氧饱和度（SpO）>0.96。在保守氧疗组中，PaO设定为70 - 100 mmHg或SpO设定为0.90 - 0.92。观察两组治疗前后的血气分析变化、机械通气时间、ICU住院时间、ICU死亡率、入院48小时后新出现的器官功能障碍及感染情况。采用Kaplan-Meier法分析两组累积生存率的差异。
治疗后，两组的pH值、PaO和氧合指数（PaO/FiO）均显著高于治疗前，动脉血二氧化碳分压（PaCO）显著低于治疗前。保守氧疗组的pH值显著高于传统氧疗组（7.4±0.1 vs. 7.3±0.3）。PaO、PaCO和PaO/FiO显著低于传统氧疗组[PaO（mmHg）：68.9±4.7 vs. 75.2±6.0，PaCO（mmHg）：42.1±5.6 vs. 50.5±7.5，PaO/FiO（mmHg）：329±126 vs. 365±108，均P < 0.05]。保守氧疗组的机械通气时间显著长于传统氧疗组（天：19.7±3.5 vs. 13.9±4.5，P < 0.05），但保守氧疗组与传统氧疗组的ICU住院时间差异无统计学意义（天：26.5±5.0 vs. 25.5±4.6，P > 0.05）。与传统氧疗组相比，保守氧疗组的ICU死亡率、医院血流感染发生率、肝功能不全、休克及ICU获得性肌无力（ICUAW）的发生率均显著降低[ICU死亡率：27.3%（15/55）vs. 45.1%（23/51），肝功能不全：1.8%（1/55）vs. 7.8%（4/51），休克：3.6%（2/55）vs. 9.8%（5/51），ICUAW：5.5%（3/55）vs. 11.8%（6/51），新血流感染发生率：5.5%（3/55）vs. 11.8%（6/51），均P < 0.05]。Kaplan-Meier分析显示，保守氧疗组的累积生存率显著高于传统氧疗组（72.7% vs. 54.9%；Log-Rank检验：χ = 4.244，P = 0.039）。
保守氧疗可降低重症肺炎患者的ICU死亡率、休克、肝功能不全、ICUAW及血流感染的发生率，但会延长机械通气时间。
