CC：动脉部分氧压与危重脓毒症患者死亡率的关系:一项全国性观察性队列研究

Background

Although several trials were conducted to optimize the oxygenation range in intensive care unit (ICU) patients, no studies have yet reached a universal recommendation on the optimal a partial pressure of oxygen in arterial blood (PaO₂) range in patients with sepsis. Our aim was to evaluate whether a relatively high arterial oxygen tension is associated with longer survival in sepsis patients compared with conservative arterial oxygen tension.

尽管已经进行了几项试验以优化重症监护病房（ICU）患者的氧合范围，但迄今为止尚无研究就脓毒症患者动脉血中的最佳氧分压（PaO2）范围达成普遍推荐。我们的目标是评估相对较高的动脉氧张力是否与保守动脉氧张力相比，与脓毒症患者较长的生存时间相关。

Methods

From the Korean Sepsis Alliance nationwide registry, patients treated with liberal PaO₂ (PaO₂ ≥ 80 mm Hg) were 1:1 matched with those treated with conservative PaO₂ (PaO₂ < 80 mm Hg) over the first three days after ICU admission according to the propensity score. The primary outcome was 28-day mortality.

来自韩国脓毒症联盟全国登记处，接受自由氧疗（PaO2 ≥ 80 mm Hg）的患者与接受保守氧疗（PaO2 < 80 mm Hg）的患者在ICU入院后的前三天根据倾向得分进行1:1匹配。主要结果是28天内死亡率。

Results

The median values of PaO₂ over the first three ICU days in 1211 liberal and 1211 conservative PaO₂ groups were, respectively, 107.2 (92.0–134.0) and 84.4 (71.2–112.0) in day 1110.0 (93.4–132.0) and 80.0 (71.0–100.0) in day 2, and 106.0 (91.9–127.4) and 78.0 (69.0–94.5) in day 3 (all p-values < 0.001). The liberal PaO₂ group showed a lower likelihood of death at day 28 (14.9%; hazard ratio [HR], 0.79; 95% confidence interval [CI] 0.65–0.96; p-value = 0.017). ICU (HR, 0.80; 95% CI 0.67–0.96; p-value = 0.019) and hospital mortalities (HR, 0.84; 95% CI 0.73–0.97; p-value = 0.020) were lower in the liberal PaO₂ group. On ICU days 2 (p-value = 0.007) and 3 (p-value < 0.001), but not ICU day 1, hyperoxia was associated with better prognosis compared with conservative oxygenation., with the lowest 28-day mortality, especially at PaO₂ of around 100 mm Hg.

在1211名接受自由氧疗和1211名接受保守氧疗的患者中，ICU前三天的动脉血氧分压（PaO2）中位数值分别为：第一天分别为107.2 mmHg（92.0–134.0）和84.4 mmHg（71.2–112.0），第二天分别为110.0 mmHg（93.4–132.0）和80.0 mmHg（71.0–100.0），第三天分别为106.0 mmHg（91.9–127.4）和78.0 mmHg（69.0–94.5），所有p值均小于0.001。自由氧疗组在第28天的死亡可能性较低（14.9%；风险比[HR]，0.79；95%置信区间[CI] 0.65–0.96；p值=0.017）。自由氧疗组的ICU（HR，0.80；95% CI 0.67–0.96；p值=0.019）和医院死亡率（HR，0.84；95% CI 0.73–0.97；p值=0.020）也较低。在ICU的第2天（p值=0.007）和第3天（p值<0.001），但不是第1天，与保守氧疗相比，高氧血症与更好的预后相关，特别是在PaO2约为100 mmHg时，28天死亡率最低。

Conclusions

In critically ill patients with sepsis, higher PaO₂ (≥ 80 mm Hg) during the first three ICU days was associated with a lower 28-day mortality compared with conservative PaO₂.

在重症脓毒症患者中，ICU前三天较高的PaO2（≥ 80 mm Hg）与保守PaO2相比，与较低的28天死亡率相关。