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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2025, Vol. 18 ›› Issue (02) : 115 -121. doi: 10.3877/cma.j.issn.1674-6880.2025.02.005

论著

氧饱和度指数联合胸部CT 对新型冠状病毒感染相关急性低氧性呼吸衰竭患者呼吸治疗决策的影响
向娇1,†(), 粟英1, 兰亚明1   
  1. 1. 445000 湖北恩施，湖北民族大学附属民大医院急诊科
  • 收稿日期:2024-07-30 出版日期:2025-04-30
  • 通信作者: 向娇
  • 基金资助:
    湖北省医学重点专科建设计划项目（ZK2019807）

Influence of respiratory rate-oxygenation index combined with chest CT on respiratory treatment decisions in patients with acute hypoxic respiratory failure related to corona virus disease 2019 infection

Jiao Xiang1,†(), Ying Su1, Yaming Lan1   

  1. 1. Department of Emergency Medicine, Minda Hospital of Hubei Minzu University, Enshi 445000, China
  • Received:2024-07-30 Published:2025-04-30
  • Corresponding author: Jiao Xiang
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向娇, 粟英, 兰亚明. 氧饱和度指数联合胸部CT 对新型冠状病毒感染相关急性低氧性呼吸衰竭患者呼吸治疗决策的影响[J/OL]. 中华危重症医学杂志(电子版), 2025, 18(02): 115-121.

Jiao Xiang, Ying Su, Yaming Lan. Influence of respiratory rate-oxygenation index combined with chest CT on respiratory treatment decisions in patients with acute hypoxic respiratory failure related to corona virus disease 2019 infection[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2025, 18(02): 115-121.

目的

分析氧饱和度（ROX）指数联合胸部CT 对新型冠状病毒感染（COVID-19）-急性低氧性呼吸衰竭（AHRF）患者呼吸治疗决策的影响。

方法

回顾性纳入2020年3月至2024年3月期间湖北民族大学附属民大医院收治的常规氧疗失败后启动经鼻高流量氧疗（HFNC）治疗的62 例COVID-19 相关AHRF 成人患者，由患者的主治医生进行机械通气（MV）适应证判断。所有患者均在入院后立即行CT 检查，采用3D Slicer 软件通过胸部CT 图像分析计算肺浸润容量（LIV）比例。记录所有患者的临床特征，并计算其入院后约6 h 的ROX 指数。采用多因素logistic回归分析评估COVID-19 相关AHRF 患者需要MV 的危险因素；使用受试者工作特征（ROC）曲线分析ROX 指数和/或LIV 预测患者需要MV 的曲线下面积（AUC）及截断值。

结果

根据接受MV 与否，将62 例COVID-19 相关AHRF 患者分为HFNC 组（35 例）和MV 组（27 例）。入院时MV组患者的血红蛋白、肌酐、乳酸脱氢酶及LIV 均显著高于HFNC 组；而ROX 指数值显著低于HFNC 组，发病至入院时间、发病至启动HFNC 时间均显著短于HFNC 组（P 均＜0.05）。多因素logistic 回归分析显示，ROX 指数≤6.55[比值比（OR）=0.141，95%置信区间（CI）（0.023，0.885），P= 0.037] 及LIV ＞33.45%[OR= 40.012，95%CI（4.833，331.273），P = 0.001] 为COVID-19 相关AHRF 患者需要MV 治疗的独立危险因素。ROC 曲线分析结果显示，ROX 指数+LIV 联合预测COVID-19 相关AHRF 患者需要MV 治疗的效能理想（曲线下面积：0.939，敏感度：92.59%，特异度：82.86%）。根据28 d 预后情况，将62 例COVID-19 相关AHRF 患者分为死亡组（6 例）和存活组（56 例），经分析，死亡组COVID-19 相关AHRF 患者的ROX 指数显著低于存活组[3.80（3.00，4.70） vs. 7.05（5.40，8.65），Z = 3.549，P ＜0.001]，而LIV 则显著高于存活组[46.75%（44.20，65.90）% vs. 32.90%（25.20，37.45）%，Z=3.786，P ＜0.001]。

结论

胸部CT 显示的LIV联合ROX 指数可以为医生在COVID-19 相关AHRF 患者的呼吸管理（HFNC 或MV）决策方面提供支持指导。

关键词: 氧饱和度指数, 胸部计算机断层扫描, 急性低氧性呼吸衰竭, 肺浸润容量

Objective

To analyze the influence of respiratory rate-oxygenation (ROX) index combined with chest CT on respiratory treatment decisions in patients with acute hypoxic respiratory failure (AHRF) related to corona virus disease 2019 infection (COVID-19).

Methods

A total of 62 adult patients with COVID-19-related AHRF who initiated high-flow nasal cannula oxygen therapy (HFNC) after the failure of conventional oxygen therapy in the Minda Hospital of Hubei Minzu University were retrospectively included from March 2020 to March 2024. The indications for mechanical ventilation (MV) were judged by attending physicians of the patients.All patients underwent CT examinations immediately after admission. The proportion of lung infiltration volume (LIV) was calculated through chest CT image analysis using 3D Slicer software. The clinical characteristics of all patients were recorded and the ROX index was calculated approximately 6 hours after admission. Multivariate logistic regression analysis was used to evaluate risk factors for the need of MV in patients with COVID-19-related AHRF. The area under the curve (AUC) and cutoff value of the ROX index and/or LIV for predicting the MV required by patients were analyzed using a receiver operating characteristic (ROC) curve.

Results

According to whether they received MV or not, 62 patients with COVID-19-related AHRF were divided into a HFNC group (35 cases) and a MV group (27 cases). At admission,the hemoglobin, creatinine, lactic dehydrogenase and LIV of patients in the MV group were significantly higher than those in the HFNC group, while the ROX index was significantly lower,and the time from the onset of the disease to admission and the time from the onset of the disease to the initiation of HFNC were significantly shorter (all P ＜0.05). Multivariate logistic regression analysis showed that the ROX index ≤6.55 [odds ratio (OR)=0.141, 95% confidence interval (CI) (0.023, 0.885),P = 0.037] and LIV ＞ 33.45% [OR = 40.012, 95%CI (4.833,331.273), P=0.001] were independent risk factors for MV treatment in patients with COVID-19-related AHRF. ROC curve analysis showed that the combination of ROX index and LIV had ideal efficacy in predicting the need for MV treatment in patients with COVID-19-related AHRF(AUC: 0.939; sensitivity: 92.59%; specificity: 82.86%). According to the prognosis at 28 days,62 patients with COVID-19-related AHRF were divided into a death group (6 cases) and a survival group (56 cases). After analysis, the ROX index of AHRF patients in the death group was significantly lower than that in the survival group [3.80 (3.00, 4.70) vs. 7.05 (5.40, 8.65),Z=3.549, P ＜0.001], while LIV was significantly higher [46.75% (44.20, 65.90)% vs. 32.90%(25.20, 37.45)%, Z=3.786, P ＜0.001].

Conclusion

The LIV combined with ROX index shown by chest CT can provide support and guidance for physicians in the decision-making of respiratory management (HFNC or MV) in patients with COVID-19-related AHRF.

Key words: Respiratory rate-oxygenation index, Chest computed tomography, Acute hypoxic respiratory failure, Lung infiltration volume
图1 一例COVID-19 相关AHRF 患者的胸部CT 平扫图像和uAI系统捕获病变图像 注：COVID-19.新型冠状病毒感染；AHRF. 急性低氧性呼吸衰竭；a 图显示患者右下肺散在磨玻璃样混浊，形状不规则，边缘模糊；b 图显示uAI 系统可以捕获受损肺容量（红色区域）进行定量分析
表1 HFNC 组和MV 组COVID-19 相关AHRF 患者的临床特征分析
指标 HNFC 组（n= 35） MV 组（n= 27） t / χ2 / Z值 P值
年龄（岁，xˉ± s ） 59 ± 15 61 ± 12 0.617 0.540
男性[例（%）] 26（74.29） 20（74.07） ＜ 0.001 0.985
BMI（kg / m2，xˉ± s ） 25 ± 4 27 ± 6 1.337 0.186
实验室检验
血红蛋白（g / L，xˉ± s ） 291 ± 59 339 ± 76 2.758 0.008
乳酸[mmol / L，M（P25，P75）] 2.10（1.30，3.30） 2.50（1.65，4.60） 0.966 0.334
PLT[× 109 / L，M（P25，P75）] 197.0（127.0，338.0） 214.0（154.5，280.5） 0.099 0.921
WBC[× 109 / L，M（P25，P75）] 6.2（5.2，11.5） 7.1（5.3，11.6） 0.469 0.639
肌酐[μmol / L，M（P25，P75）] 66.30（57.02，77.79） 98.13（67.63，133.04） 2.855 0.004
CRP[mg / L，M（P25，P75）] 88.9（33.1，144.4） 112.5（49.3，155.0） 0.802 0.422
LDH[U / L，M（P25，P75）] 387.0（348.5，429.0） 449.0（372.0，704.0） 2.563 0.010
PT[s，M（P25，P75）] 16.00（14.35，20.20） 16.50（13.65，21.10） 0.043 0.966
DD[μg / L，M（P25，P75）] 0.80（0.60，1.45） 1.20（0.80，2.25） 1.940 0.052
PSI[M（P25，P75）] 79.0（67.0，109.5） 89.0（75.0，149.0） 1.519 0.129
SOFA[分，M（P25，P75）] 6.0（4.5，11.0） 6.0（3.0，8.5） 1.347 0.178
APACHEⅢ评分[分，M（P25，P75）] 66.00（46.00，87.00） 50.00（43.50，79.00） 1.222 0.222
CCI[M（P25，P75）] 1.00（1.00，2.00） 2.00（1.00，2.00） 1.116 0.264
ROX 指数[M（P25，P75）] 7.90（6.30，9.65） 5.30（4.55，6.50） 4.304 ＜ 0.001
LIV[%，M（P25，P75）] 26.30（22.00，33.15） 40.60（35.70，44.15） 5.374 ＜ 0.001
发病至入院时间（d，，xˉ± s ） 9.7 ± 2.7 7.7 ± 3.2 2.678 0.010
发病至启动HFNC 时间（d，xˉ± s ） 9.8 ± 2.7 7.5 ± 2.6 3.326 0.002
表2 多因素logistic 回归分析影响COVID-19 相关AHRF 患者需要MV 的危险因素
自变量 赋值 回归系数 标准误 Wald 值 OR 值 95%CI P值
0 1
血红蛋白（g / L） ≤302.0 ＞ 302.0 0.831 0.905 0.843 2.296 0.390 ～ 13.526 0.358
肌酐（μmol / L） ≤72.05 ＞ 72.05 0.368 0.965 0.146 1.445 0.218 ～ 9.580 0.703
LDH（U / L） ≤417.0 ＞ 417.0 1.379 0.924 2.226 3.971 0.649 ～ 24.311 0.136
ROX 指数 ≤6.55 ＞ 6.55 -1.958 0.937 4.370 0.141 0.023 ～ 0.885 0.037
LIV（%） ≤33.45 ＞ 33.45 3.689 1.078 11.701 40.012 4.833 ～ 331.273 0.001
发病至入院时间（d） ≤9.0 ＞ 9.0 -1.072 1.079 0.986 0.342 0.041 ～ 2.839 0.321
发病至启动HFNC 时间（d） ≤9.0 ＞ 9.0 -0.966 1.046 0.854 0.380 0.049 ～ 2.953 0.355
表3 ROX 指数和LIV 预测COVID-19 相关AHRF 患者需要MV 的ROC 曲线分析
变量 AUC 95%CI P值 敏感度（%） 特异度（%） 截断值 阳性预测值（%） 阴性预测值（%）
ROX 指数 0.821 0.702 ～ 0.907 ＜ 0.001 66.67 85.71 5.80 83.28 70.66
LIV（%） 0.901 0.798 ～ 0.962 ＜ 0.001 77.78 91.43 35.60 90.65 79.40
ROX 指数+ LIV 0.939 0.847 ～ 0.984 ＜ 0.001 92.59 82.86 0.25 85.23 91.28
图2 ROX 指数和LIV 预测COVID-19 相关AHRF 患者需要MV 的ROC 曲线 注：ROX.氧饱和度；LIV.肺浸润体积；COVID-19.新型冠状病毒感染；AHRF.急性低氧性呼吸衰竭；MV.机械通气；ROC.受试者工作特征
1
岳伟岗，蒋由飞，尹瑞元，等. 经鼻高流量氧疗对急性低氧性呼吸衰竭患者住院病死率的累积Meta 分析[J/OL].中华危重症医学杂志（电子版），2024，17（1）：39-44.
2
高敏，石泽亚，韩小彤，等. 经鼻高流量湿化氧疗在急性呼吸衰竭患者中应用效果的回顾性研究[J]. 中国实用护理杂志，2022，38（5）：327-332.
3
Panadero C, Abad-Fernández A, Rio-Ramirez MT, et al.High-flow nasal cannula for Acute Respiratory Distress Syndrome (ARDS) due to COVID-19 [J]. Multidiscip Respir Med, 2020, 15 (1): 693.
4
Sudo K, Sawa T, Kushimoto K, et al. Choice of respiratory therapy for COVID-19 patients with acute hypoxemic respiratory failure: a retrospective case series study[J]. PeerJ, 2023 (11): e15174.
5
Grieco DL, Maggiore SM, Roca O, et al. Non-invasive ventilatory support and high-flow nasal oxygen as firstline treatment of acute hypoxemic respiratory failure and ARDS[J]. Intensive Care Med, 2021, 47 (8): 851-866.
6
Kansal A, Ong WJD, Dhanvijay S, et al. Comparison of ROX index (SpO2/FIO2 ratio /respiratory rate) with a modified dynamic index incorporating PaO2 / FIO2 ratio and heart rate to predict high flow nasal cannula outcomes among patients with acute respiratory failure:a single centre retrospective study[J]. BMC Pulm Med,2022, 22 (1): 350.
7
Goh KJ, Chai HZ, Ong TH, et al. Early prediction of high flow nasal cannula therapy outcomes using a modified ROX index incorporating heart rate [J]. J Intensive Care, 2020, 8: 41.
8
Roca O, Caralt B, Messika J, et al. An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy [J]. Am J Respir Crit Care Med, 2019, 199 (11): 1368-1376.
9
Booker J, Egglestone R, Lushington J, et al. Detailed analysis of primary non-invasive respiratory support and outcomes of subjects with COVID-19 acute hypoxaemic respiratory failure[J]. Cureus, 2022, 14 (12): e32362.
10
Lun CT, Leung CK, Shum HP, et al. Predictive factors for high-flow nasal cannula failure in acute hypoxemic respiratory failure in an intensive care unit[J]. Lung India, 2022, 39 (1): 5-11.
11
Prakash J, Bhattacharya PK, Yadav AK, et al. ROX index as a good predictor of high flow nasal cannula failure in COVID-19 patients with acute hypoxemic respiratory failure: a systematic review and metaanalysis[J]. J Crit Care, 2021, 66: 102-108.
12
刘彦飞，许程飞，黄艳林. ROX 指数在经鼻高流量氧疗患者中的早期临床应用及预测[J]. 中华危重病急救医学，2023，35（8）：823-827.
13
Junhai Z, Jing Y, Beibei C, et al. The value of ROX index in predicting the outcome of high flow nasal cannula: a systematic review and meta-analysis [J].Respir Res, 2022, 23 (1): 33.
14
Praphruetkit N, Boonchana N, Monsomboon A, et al.ROX index versus HACOR scale in predicting success and failure of high-flow nasal cannula in the emergency department for patients with acute hypoxemicrespiratoryfailure:aprospective observational study[J]. Int J Emerg Med, 2023, 16 (1):3.
15
Zhou X, Liu J, Pan J, et al. The ROX index as a predictor of high-flow nasal cannula outcome in pneumonia patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis[J]. BMC Pulm Med, 2022, 22 (1): 121.
16
Arcari L, Ciolina F, Cacciotti L, et al. Semiquantitative chest CT severity score predicts failure of noninvasive positive-pressure ventilation in patients hospitalized for COVID-19 pneumonia [J].J Cardiothorac Vasc Anesth, 2022, 36 (8 Pt A): 2278-2286.
17
Kücük M, Ergan B, Yakar MN, et al. The predictive values of respiratory rate oxygenation index and chest computed tomography severity score for high-flow nasal oxygen failure in critically ill patients with coronavirus disease-2019[J]. Balkan Med J, 2022, 39 (2): 140-147.
18
Li K, Fang Y, Li W, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19)[J]. Eur Radiol, 2020,30 (8): 4407-4416.
19
Tharwat S, Saleh GA, Saleh M, et al. Chest CT total severity score on admission to predict in-hospital mortality in COVID-19 patients with acute and chronic renal impairment[J]. Diagnostics (Basel), 2022, 12 (7):1529.
20
Zhang HT, Zhang JS, Zhang HH, et al. Automated detection and quantification of COVID-19 pneumonia:CT imaging analysis by a deep learning-based software[J]. Eur J Nucl Med Mol Imaging, 2020, 47 (11):2525-2532.
21
Liu G, Du C, Du W, et al. The clinical features of severe COVID-19 with respiratory failure: a Chinese single-centerretrospectivestudy[J].Medicine(Baltimore), 2023, 102 (48): e36110.
22
Chan AJY, Lung KC, Yu JSY, et al. Twenty-eight-day mortality among patients with severe or critical COVID-19 in Hong Kong during the early stages of the pandemic [J]. Hong Kong Med J, 2023, 29 (5): 383-395.
[1] 岳伟岗, 蒋由飞, 尹瑞元, 吴雨晨, 曾丽, 田金徽. 经鼻高流量氧疗对急性低氧性呼吸衰竭患者住院病死率的累积Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(01): 39-44.
[2] 程玲燕, 卢嘉宾, 韦庆, 兰祖. 急性低氧性呼吸衰竭乳酸/白蛋白比值与病死率相关性分析[J/OL]. 中华肺部疾病杂志(电子版), 2023, 16(05): 654-657.
[3] 汪俊谷, 潘华琴, 杨雨田. HFNC治疗急性低氧性呼吸衰竭插管预后及影响因素分析[J/OL]. 中华肺部疾病杂志(电子版), 2023, 16(04): 523-525.
[4] 张银, 丁薇, 周晓莉, 赵云峰, 许德凤. 胸部CT扫描测定肺动脉与主动脉直径比值与慢性阻塞性肺疾病的关系[J/OL]. 中华肺部疾病杂志(电子版), 2017, 10(01): 95-97.
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