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脓毒症患者住院期间术后氧分压水平与预后的相关性研究。

The correlation study between post-surgery oxygen partial pressure level and prognosis of patients with sepsis during hospitalization.

作者信息

Wang Anqi, Chen Jieying, Gao Jianling

机构信息

Department of Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China.

出版信息

Medicine (Baltimore). 2025 Jun 6;104(23):e42449. doi: 10.1097/MD.0000000000042449.

Abstract

Sepsis remains a leading cause of mortality and healthcare burden, necessitating improved diagnostic and therapeutic strategies. Observational studies suggest that hyperoxemia may improve postoperative sepsis outcomes, but evidence remains limited. This study aims to explore the optimal range of oxygen partial pressure (PaO2) in postsurgical sepsis patients and its impact on prognosis. Clinical data of adult sepsis patients were extracted from the medical information mart for intensive care-IV database. Patients were categorized into control (PaO2 ≤ 100 mm Hg) and hyperoxemia (PaO2 > 100 mm Hg) groups. Primary outcome was 90-day mortality, while secondary outcomes included 1-year mortality, intensive care unit (ICU)/hospital length of stay, and invasive ventilation duration. Restricted cubic spline analysis stratified postsurgical PaO2 into normal (≤128.7 mm Hg), mild hyperoxemia (128.7-162.1 mm Hg), and severe hyperoxemia (≥162.1 mm Hg). Kaplan-Meier survival analysis and multivariate regression were conducted. Among 1220 patients, hyperoxemia patients were younger, had lower disease severity, and received more aggressive treatment. They had lower rates of acute respiratory failure and acute kidney injury. After cubic spline-based classification, mild hyperoxemia was associated with lower 90-day mortality (OR: 0.54, 95% CI: 0.34-0.86, P = .010), while severe hyperoxemia showed no significant effect (OR: 0.60, 95% CI: 0.30-1.20, P = .147). Kaplan-Meier curves demonstrated significantly improved long-term survival for mild hyperoxemia patients. Mild hyperoxemia in postsurgical sepsis patients is associated with reduced 90-day mortality, suggesting a potential optimal oxygenation range for better outcomes.

摘要

脓毒症仍然是导致死亡和造成医疗负担的主要原因,因此需要改进诊断和治疗策略。观察性研究表明,高氧血症可能改善术后脓毒症的预后,但证据仍然有限。本研究旨在探讨术后脓毒症患者的最佳氧分压(PaO2)范围及其对预后的影响。从重症监护-IV数据库的医学信息集市中提取成年脓毒症患者的临床数据。将患者分为对照组(PaO2≤100mmHg)和高氧血症组(PaO2>100mmHg)。主要结局是90天死亡率,次要结局包括1年死亡率、重症监护病房(ICU)/住院时间和有创通气时间。受限立方样条分析将术后PaO2分为正常(≤128.7mmHg)、轻度高氧血症(128.7-162.1mmHg)和重度高氧血症(≥162.1mmHg)。进行了Kaplan-Meier生存分析和多变量回归分析。在1220例患者中,高氧血症患者更年轻,疾病严重程度更低,接受的治疗更积极。他们发生急性呼吸衰竭和急性肾损伤的几率更低。基于立方样条分类后,轻度高氧血症与较低的90天死亡率相关(OR:0.54,95%CI:0.34-0.86,P = 0.010),而重度高氧血症未显示出显著影响(OR:0.60,95%CI:0.30-1.20,P = 0.147)。Kaplan-Meier曲线显示轻度高氧血症患者的长期生存率显著提高。术后脓毒症患者的轻度高氧血症与90天死亡率降低相关,提示可能存在一个潜在的最佳氧合范围以获得更好的预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3f6f/12151029/1dd8624e641f/medi-104-e42449-g001.jpg

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