中国全科医学2025，Vol.28Issue(20)：2516-2522,7.DOI:10.12114/j.issn.1007-9572.2024.0072
无创机械通气患者呼吸驱动指标与吸痰后血氧饱和度剧烈下降的相关性研究
Study on the Relationship between Respiratory Drive Index and Oxygenation after Sputum Aspiration in Patients with Noninvasive Mechanical Ventilation
荆晨晨 1王艳如 1王淑娟 1徐辉辉 1邢卿1
作者信息
- 1. 266071 山东省青岛市市立医院急诊科
- 折叠
摘要
Abstract
Background Non-invasive positive pressure ventilation(NIPPV)is one of the important methods to treat acute exacerbation of chronic obstructive pulmonary disease(AECOPD).NIPPV combined with airway clearance therapy can effectively avoid endotracheal intubation and reduced length of hospital stay.The pathological characteristics of AECOPD make the indication of routine evaluation of airway suction lose its guiding value,frequent or delayed airway sputum aspiration is not beneficial to the positive pressure ventilation treatment of patients with acute phase of disease.Objective To establish the relationship between the oxygenation dropped dramatically after suction and respiratory effort index(ROX index and VOX index)in patients with AECOPD treated with NIPPV,and the predictive value of respiratory drive index on the time of suction.Methods Convenience sampling method was used,to investigate 140 AECOPD patients with NIPPV treated in the emergency intensive care unit of Qingdao Municipal Hospital from October 2022 to November 2023,the ROX index and VOX index were monitored and calculated within 24 h of non-invasive positive pressure ventilation and during sputum aspiration,the frequency and duration of a dramatic drop in SpO2(>10%)after sputum aspiration were assessed.Then analyzed the correlation between ROX index,VOX index and SpO2 sharp drop after sputum aspiration,and ROX index and VOX index were plotted to predict the receiver operating characteristic(ROC)curve of SpO2 sharp drop after sputum aspiration.Results One hundred and forty patients within 24 hours a total of 861 sputum aspiration,SpO2 decreased sharply after sputum aspiration in 98 patients(70.0%);in 96 patients(68.6%),the incidence of SpO2 decrease was more than 60%;in 75 patients(53.6%),SpO2 decreased dramatically for 16-30 seconds,and in 10 patients(7.1%),SpO2 decreased more than 30 seconds.The baseline ROX index and the ROX index 1 hour before sputum aspiration were negatively correlated with the incidence and duration of SpO2 decrease after sputum aspiration(P<0.05),baseline VOX index and VOX index 1 hour before sputum aspiration were positively correlated with the incidence and duration of SpO2 sharp decline after sputum aspiration(P<0.05).The area under the ROC curve of the baseline VOX index was 0.970(95%CI=0.939-0.967),the best threshold was 0.007 4;the area under the ROC curve of the VOX index 1 hour before sputum aspiration was 0.893(95%CI=0.826-0.959),the best threshold was 0.008 7.Conclusion When VOX index≥0.007 4 after 1 h of NIPPV and VOX index≥0.008 7 within 1 h before sputum aspiration,we should be alert to the occurrence of dramatic SpO2 reduction after sputum aspiration.关键词
慢性阻塞性肺疾病/无创通气/抽吸/经皮血气监测/ROX指数/VOX指数Key words
Chronic obstructive pulmonary disease/Noninvasive ventilation/Suction/Transcutaneous blood gas monitoring/ROX index/VOX index分类
临床医学引用本文复制引用
荆晨晨,王艳如,王淑娟,徐辉辉,邢卿..无创机械通气患者呼吸驱动指标与吸痰后血氧饱和度剧烈下降的相关性研究[J].中国全科医学,2025,28(20):2516-2522,7.
