| 摘要: |
| ［摘要］ 目的 分析文丘里面罩吸氧治疗后急性低氧性呼吸衰竭（AHRF）患者临床转归不良的影响因素，并构建列线图模型。方法 回顾性分析2021年11月至2024年4月安庆市中医医院收治的203例AHRF患者的临床资料，均接受文丘里面罩吸氧治疗，根据患者治疗后临床转归情况将其分为不良组（57例）和良好组（146例）。通过多因素logistic回归分析影响文丘里面罩吸氧治疗后AHRF患者临床转归的因素，并基于筛得指标构建预测文丘里面罩吸氧治疗后AHRF患者临床转归不良的列线图模型。通过受试者工作特征（ROC）曲线、Hosmer-Lemeshow检验、校准曲线和决策曲线评价列线图模型的预测效能和应用价值。结果 203例患者中临床转归不良57例（28.08%），其中转为机械通气45例，出现病情恶化导致抢救10例，死亡2例。多因素logistic回归分析结果显示，较大的年龄［OR（95%CI）=1.754（1.040～2.958）］、较高的APACHE Ⅱ评分［OR（95%CI）=2.373（1.535～3.669）］、出现发热［OR（95%CI）=2.274（1.170～4.419）］以及合并多器官功能障碍综合征（MODS）［OR（95%CI）=1.635（1.093～2.446）］是文丘里面罩吸氧治疗后AHRF患者临床转归不良的独立危险因素（P<0.05），治疗1 h后ROX指数高［OR（95%CI）=0.556（0.364～0.849）］是促进患者临床转归良好的独立保护因素（P<0.05）。基于年龄、发热、合并MODS、APACHE Ⅱ评分以及治疗1 h后ROX指数构建预测文丘里面罩吸氧治疗后AHRF患者临床转归不良的列线图模型，ROC曲线分析结果显示该列线图模型具有较好的预测效能［AUC（95%CI）=0.925（0.880～0.957），P<0.001］，灵敏度为92.98%，特异度为85.62%。Hosmer-Lemeshow检验结果显示，列线图模型预测患者临床转归不良的概率与实际概率比较差异无统计学意义（χ2=0.859，P=0.354）。校准曲线显示，列线图模型的预测概率与实际发生概率具有良好的一致性。决策曲线提示该模型可应用于绝大多数临床决策场景。结论 年龄、发热、合并MODS、APACHE Ⅱ评分以及治疗1 h后ROX指数是影响文丘里面罩吸氧治疗后AHRF患者临床转归的因素，基于这些指标构建的列线图模型有助于临床快速决策，改善患者预后，具有较好的临床应用价值。 |
| 关键词: 急性低氧性呼吸衰竭 文丘里面罩 氧疗 临床转归 影响因素 列线图 |
| DOI：10.3969/j.issn.1674-3806.2025.10.13 |
| 分类号:R 563.8 |
| 基金项目:安庆市科学技术局医疗卫生类科技计划项目（编号：2024Z6001） |
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| Analysis of factors influencing poor clinical outcomes in patients with acute hypoxemic respiratory failure after Venturi mask oxygen therapy and construction of a nomogram model |
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JIANG Long1, FANG Hui1, XIA Yunqing2,HU Ai3, LI Bisheng4, WANG Lingling1, WANG Rui1, WANG Bin1
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1.Department of Critical Care Medicine, Anqing Hospital of Chinese Medicine(Affiliated Hospital of Anqing Medical College), Anqing 246000, China; 2.Department of Laboratory Medicine, Anqing Hospital of Chinese Medicine(Affiliated Hospital of Anqing Medical College), Anqing 246000, China; 3.Department of Emergency, Anqing Hospital of Chinese Medicine(Affiliated Hospital of Anqing Medical College), Anqing 246000, China; 4.Department of Respiratory Medicine, Anqing Hospital of Chinese Medicine(Affiliated Hospital of Anqing Medical College), Anqing 246000, China
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| Abstract: |
| ［Abstract］ Objective To analyze the factors influencing poor clinical outcomes in patients with acute hypoxemic respiratory failure(AHRF) after Venturi mask oxygen therapy and to construct a nomogram model. Methods A retrospective analysis was conducted on the clinical data of 203 patients with AHRF who were admitted to Anqing Hospital of Chinese Medicine from November 2021 to April 2024. All these patients received Venturi mask oxygen therapy. According to the clinical outcomes of the patients after the therapy, they were divided into poor outcome group(57 patients) and good outcome group(146 patients). Multivariate logistic regression was used to analyze the factors influencing the clinical outcomes of patients with AHRF after Venturi mask oxygen therapy, and a nomogram model for predicting poor clinical outcomes of patients with AHRF after Venturi mask oxygen therapy was constructed based on the screened indicators. The predictive efficiency and application value of the constructed nomogram model were evaluated through receiver operating characteristic(ROC) curve, Hosmer-Lemeshow test, calibration curve and decision curve. Results In the 203 patients, 57 patients(28.08%) had poor clinical outcomes. Among the 57 patients with poor clinical outcomes, 45 patients were converted to mechanical ventilation, and 10 patients had deteriorated conditions leading to rescue, and 2 patients died. The results of multivariate logistic regression analysis showed that older age［OR(95%CI)=1.754(1.040-2.958)］, higher Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) scores［OR(95%CI)=2.373(1.535-3.669)］, fever［OR(95%CI)=2.274(1.170-4.419)］ and concurrent multiple organ dysfunction syndrome(MODS)［OR(95%CI)=1.635(1.093-2.446)］ were independent risk factors for poor clinical outcomes in patients with AHRF after Venturi mask oxygen therapy(P<0.05). A high respiratory rate-oxygenation(ROX) index at 1 hour after treatment［OR(95%CI)=0.556(0.364-0.849)］ was an independent protective factor for promoting good clinical outcomes in the patients(P<0.05). A nomogram model for predicting poor clinical outcomes in patients with AHRF after Venturi mask oxygen therapy was constructed on basis of age, fever, concurrent MODS, APACHE Ⅱ scores and ROX index at 1 hour after treatment. The results of ROC curve analysis showed that the nomogram model had good predictive efficiency［AUC(95%CI)=0.925(0.880-0.957), P<0.001］, with a sensitivity of 92.98% and a specificity of 85.62%. The results of Hosmer-Lemeshow test showed that there was no statistically significant difference between the probability of the patients′ poor clinical outcomes predicted by the nomogram model and the actual probability(χ2=0.859, P=0.354). The calibration curve showed that the predicted probability of the nomogram model had a good consistency with the actual probability. The decision curve indicated that the nomogram model could be applied to the vast majority of clinical decision-making settings. Conclusion Age, fever, concurrent MODS, APACHE Ⅱ scores, and the ROX index at 1 hour after treatment are the factors influencing the clinical outcomes of AHRF patients after Venturi mask oxygen therapy. The nomogram model constructed on basis of these indicators is helpful for rapid clinical decision-making, improves the patients′ prognosis, and has good clinical application value. |
| Key words: Acute hypoxemic respiratory failure(AHRF) Venturi mask Oxygen therapy Clinical outcomes Influencing factors Nomogram |
