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ENGLISH ABSTRACT
基于间接测热法的耗氧量与二氧化碳生成量对重度ARDS患者死亡风险的预测研究
关珂
邹辉煌
胡玉娜
叶岭
程艳伟
牛京京
王存真
秦柯
张廷源
杨斌
孙玉寒
朱文亮
樊清波
郭志松
陈永春
王文杰
作者及单位信息
·
DOI： 10.3760/cma.j.issn.1671-0282.2025.03.017
Predicting mortality risk in severe ards patients using indirect calorimetry-based oxygen consumption and carbon dioxide production rates
Guan Ke
Zou Huihuang
Hu Yuna
Ye Ling
Cheng Yanwei
Niu Jingjing
Wang Cunzhen
Qin Ke
Zhang Tingyuan
Yang Bin
Sun Yuhan
Zhu Wenliang
Fan Qingbo
Guo Zhisong
Chen Yongchun
Wang Wenjie
Authors Info & Affiliations
Guan Ke
Department of Clinical Nutrition, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, 450003, China
Zou Huihuang
Department of Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, 450003, China
Hu Yuna
Department of Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, 450003, China
Ye Ling
Department of Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, 450003, China
Cheng Yanwei
Department of Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, 450003, China
Niu Jingjing
Department of Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, 450003, China
Wang Cunzhen
Department of Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, 450003, China
Qin Ke
Department of Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, 450003, China
Zhang Tingyuan
Department of Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, 450003, China
Yang Bin
Department of Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, 450003, China
Sun Yuhan
Department of Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, 450003, China
Zhu Wenliang
Department of Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, 450003, China
Fan Qingbo
Department of Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, 450003, China
Guo Zhisong
Department of Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, 450003, China
Chen Yongchun
Department of Clinical Nutrition, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, 450003, China
Wang Wenjie
Department of Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, 450003, China
·
DOI： 10.3760/cma.j.issn.1671-0282.2025.03.017
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摘要

目的探索重度急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS）患者耗氧量、二氧化碳生成量及耗氧量/乳酸与死亡风险的关系。

方法采用回顾性队列研究方法，研究对象为2020年3月1日至2023年6月30日在河南省人民医院中心ICU住院>5 d的重度ARDS成年患者，排除入ICU第4天未能完成IC检测，IC检测结果不可靠，其他ICU转入或入科时机械通气时长已超过48 h，姑息治疗者及孕产妇。使用间接测热法于入ICU第4天检测耗氧量、二氧化碳生成量，查阅病历获取一般情况、疾病信息、血气分析（含乳酸值）、诊疗措施等，电话随访死亡及死亡时间。主要结局指标为90 d死亡，次要结局指标为28 d死亡、ICU住院天数、总住院天数、住院总花费。分别采用Cox回归分析、线性回归分析方法探讨耗氧量、二氧化碳生成量及耗氧量/乳酸与主要、次要结局指标的关系。

结果共216例患者纳入本研究，90 d死亡78例患者（36.1%），存活138例患者（63.9%）。校正混杂因素后的多因素Cox回归分析结果提示，与Q4组相比，耗氧量Q1、Q2组90 d死亡风险的 HR(95% CI)分别是3.21（1.38~7.49）及3.24（1.42~7.38），二氧化碳生成量Q1、Q2、Q3组90 d死亡风险的 HR(95% CI)分别是5.88（2.33~14.84）、4.26（1.60~11.34）及3.54（1.34~9.35），耗氧量/乳酸Q1、Q2、Q3组90 d死亡风险的 HR(95% CI)分别是8.72（3.01~25.25）、8.43（2.91~24.47）及4.04（1.34~12.17）。 P-trend均<0.05，提示耗氧量、二氧化碳生成量及耗氧量/乳酸与90 d死亡风险线性负相关。此外，耗氧量、二氧化碳生成量及耗氧量/乳酸与28 d死亡风险负相关，耗氧量/乳酸与ICU住院时长负相关。

结论耗氧量、二氧化碳生成量及耗氧量/乳酸与重症ARDS患者90 d死亡风险及28 d死亡风险负相关，可能是该类患者死亡风险的独立危险因素。

重度急性呼吸窘迫综合征;间接测热法;耗氧量;二氧化碳生成量
ABSTRACT

ObjectiveTo investigate the relationship between oxygen consumption (VO 2), carbon dioxide production (VCO 2), and Oxygen Consumption/lactate (VO 2/Lac) with risk of death in patients with severe ARDS.

MethodsA retrospective cohort study method was used, and the study subjects were hospitalized for >5 days adult patients with severe ARDS in the central intensive care unit of Henan Provincial People's Hospital from 1 March 2020 to 30 June 2023. The following patients were excluded: IC test was not completed on the 4th day of ICU admission, IC test results were unreliable, mechanical ventilation duration had exceeded 48 h at the time of ICU transfer or admission, palliative care patients and pregnant and parturient women. Using indirect calorimetry to determine VO 2 and VCO 2 values on the 4th day of admission, reviewing medical records to obtain general condition, disease information, blood gas analysis (including lactate value), diagnostic and therapeutic measures, and following up deaths by telephone and time of death. The primary outcome measure was death at 90 days, and the secondary outcome measure was death at 28 days, length of stay in ICU, total length of stay, and total hospitalization cost. Cox regression analysis and linear regression analysis were used to investigate the relationship between VO 2, VCO 2, VO 2/Lac and primary and secondary outcome indexes.

ResultsA total of 216 patients were enrolled, 78 patients (36.1%) died and 138 patients (63.9%) survived at 90 days. After correction for confounders, the results of multifactorial Cox regression analysis suggested that compared with the Q4 group, HR (95% CI) for 90-day risk of death in the VO 2 Q1 and Q2 groups was 3.21 (1.38, 7.49) and 3.24 (1.42, 7.38), and HR (95% CI) for 90-day risk of death in the VCO 2 Q1, Q2 and Q3 groups was 5.88 (2.33, 14.84), 4.26 (1. 60, 11.34) and 3.54 (1.34, 9.35), respectively, and the HR (95% CI) for 90-day risk of death in the VO 2/Lac Q1, Q2 and Q3 groups were 8.72 (3.01, 25.25), 8.43 (2.91, 24.47) and 4.04 (1.34, 12.17) respectively. P-trends were all <0.05, indicating that VO 2, VCO 2 and VO 2/Lac were linearly and negatively associated with the risk of 90-day mortality. In addition, VO 2, VCO 2, and VO 2/Lac were negatively associated with 28-day risk of death and higher VO 2/Lac was negatively associated with length of ICU stay.

ConclusionsVO 2, VCO 2 and VO 2/Lac were negatively associated with 90-day mortality risk and 28-day mortality risk in patients with severe ARDS and may be independent risk factors predicting mortality risk of such patients.

Severe ARDS;Indirect calorimetry;Oxygen consumption;Carbon dioxide production
Wang Wenjie, Email: mocdef.3ab61jwgnawrotcod
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引用本文

关珂,邹辉煌,胡玉娜,等. 基于间接测热法的耗氧量与二氧化碳生成量对重度ARDS患者死亡风险的预测研究[J]. 中华急诊医学杂志,2025,34(03)：396-403.

DOI:10.3760/cma.j.issn.1671-0282.2025.03.017

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急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）是由肺内、外严重疾病导致，以肺毛细血管弥漫性损伤、通透性增强为基础，以肺水肿、透明膜形成和肺不张为主要病理变化，以进行性呼吸窘迫和难治性低氧血症为临床特征的综合征 [ 1 , 2 ]。ARDS患者除氧摄取障碍外，常因炎症反应而伴有线粒体损伤（被称为"细胞病变性缺氧"），导致细胞代谢改变、氧气利用受损及器官功能障碍 [ 3 ]。耗氧量是单位时间内机体摄取并被实际消耗或利用的氧量,是衡量氧输送不足、微循环灌注、线粒体功能的指标 [ 4 ]，二氧化碳生成量与通气量、心输出量、细胞代谢、酸碱平衡等多个因素相关 [ 5 ]。此外，研究表明调节线粒体动力学是有效的肺部疾病治疗措施 [ 6 ]，因此监测耗氧量及二氧化碳生成量有望帮助检测ARDS患者病情进展及治疗效果 [ 7 ]。间接测热法（indirect calorimetry, IC）可以同时、无创地测量二氧化碳生成量和耗氧量 [ 8 , 9 ]，它已经在ICU中用于测量能量消耗（energy expenditure, EE） [ 10 , 11 ]和耗氧量，不仅可以提供估计营养需求的信息，还可以提供组织代谢的信息 [ 12 , 13 ]。
国外有少数IC法检测的耗氧量及二氧化碳生成量与重症患者临床结局关系的研究，发现与脓毒症28 d存活患者相比，死亡患者耗氧量及二氧化碳生成量下降、乳酸清除率降低 [ 14 ]，脓毒症死亡患者耗氧量/乳酸显著低于存活者 [ 15 ]，心搏骤停患者自主循环恢复后12 h内的耗氧量与院内生存率正相关，超过24 h后无显著相关性，生存者的耗氧量/乳酸显著高于死亡者，二氧化碳生成量与院内生存率无关 [ 4 ]。目前国内暂无相关研究，国外已有研究少、样本量小、随访时间较短，且尚无关于ARDS患者的此类研究，此外，鉴于上述有研究认为单一耗氧量与临床结局关联无统计学意义，而低耗氧量/乳酸是院内死亡的危险因素，因此本研究拟采用回顾性队列研究方法，初步探讨IC法检测的耗氧量、二氧化碳生成量及耗氧量/乳酸与重度ARDS患者死亡风险的关系。
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备注信息
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王文杰，Email: mocdef.3ab61jwgnawrotcod
B

关珂：酝酿和设计研究，实施研究，采集数据，分析/解释数据，起草文章，统计分析；邹辉煌：酝酿和设计实验，实施研究，采集数据；胡玉娜：酝酿和设计实验，实施研究，采集数据；叶岭：实施研究，采集数据，分析/解释数据，统计分析；程艳伟：采集数据，分析/解释数据，统计分析，参与文章撰写及修改；牛京京、王存真、秦柯、张廷源、杨斌、孙玉寒、朱文亮：实施研究，采集数据；樊清波、郭志松、陈永春：行政、技术或材料支持，指导，支持性贡献；王文杰：酝酿和设计实验，实施研究，采集数据，分析/解释数据，对文章的知识性内容作批评性审阅，获取研究经费，行政、技术或材料支持，指导，支持性贡献

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河南省医学科技攻关计划联合共建项目 (LHGJ20230020)
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