浙江医学2025，Vol.47Issue(14)：1494-1499,6.DOI:10.12056/j.issn.1006-2785.2025.47.14.2024-2093
基于ROX指数经鼻高流量湿化氧疗脓毒症患者死亡风险与机械通气启动时机探讨
Exploring mortality risk and the timing for initiating mechanical ventilation in sepsis patients receiving high-flow nasal cannula oxygen therapy based on the ROX index
叶渊文 1李飞飞 1杨宝华 1林连根 1吕望 1陈玲珑1
作者信息
摘要
Abstract
Objective To explore the application value of the respiratory rate oxygenation(ROX)index in predicting the failure of high-flow nasal cannula(HFNC)oxygen therapy and determining the initiation timing of mechanical ventilation in septic patients.Methods This study adopted a case-control design,with data of 35 010 septic patients derived from the Multiparameter Intelligent Monitoring in Intensive Care Ⅳ database.After strict screening,116 patients were finally included.Patients were divided into a survival group and a death group based on in-hospital mortality.Restricted cubic spline(RCS)analysis was used to visualize the non-linear relationship between the ROX index at the initiation of mechanical ventilation and in-hospital mortality,and the ROX threshold was determined.Patients were divided into high-ROX index and low-ROX index groups according to the threshold.Multivariate logistic regression analysis was performed to verify the relationship between the ROX index and in-hospital mortality,and Kaplan-Meier curves were plotted to assess the relationship between the ROX index and 90-day all-cause mortality.Results There were 92 patients(79.31％)in the survival group and 24 patients(20.69％)in the death group.RCS analysis showed a non-linear relationship between the ROX index and in-hospital mortality in septic patients(P=0.015).With the increase of the ROX index,the in-hospital mortality gradually decreased until reaching the threshold(4.40).When the ROX index was lower than the threshold,the in-hospital mortality significantly decreased with further increases of the ROX index;when the ROX index exceeded the threshold,the in-hospital mortality tended to be stabilized.Multivariate logistic regression analysis further confirmed that compared with the high-ROX index group,the low-ROX index group had a higher in-hospital mortality(OR=7.105,95％CI:2.248-22.461,P＜0.05),and this result remained stable after adjusting for confounding factors.Kaplan-Meier survival curve analysis showed that the low-ROX index group had a higher 90-day all-cause mortality than the high-ROX index group(P=0.021).Conclusion There is a significant non-linear relationship between the ROX index and in-hospital mortality.Patients who receive mechanical ventilation with a ROX index＜4.40 have a significantly increased risk of in-hospital death,and early initiation of mechanical ventilation is recommended to reduce this risk.关键词
经鼻高流量湿化氧疗/脓毒症/呼吸频率氧合指数/机械通气/启动时机Key words
High-flow nasal cannula oxygen therapy/Sepsis/Respiratory rate oxygenation index/Mechanical ventilation/Initiation timing引用本文复制引用
叶渊文,李飞飞,杨宝华,林连根,吕望,陈玲珑..基于ROX指数经鼻高流量湿化氧疗脓毒症患者死亡风险与机械通气启动时机探讨[J].浙江医学,2025,47(14):1494-1499,6.
