目的:分析预出院、生活基本自理的慢性阻塞性肺疾病(慢阻肺)患者发生早期运动性低氧的外周经皮血氧饱和度(saturation of peripheral oxygen,SpO2)波动特点及危险因素.方法:纳入蚌埠医科大学附属合肥市第二人民医院呼吸与危重症医学科2021年5月至2024年5月预出院、生活基本自理的慢阻肺患者142例,根据6分钟步行试验(6-minute walk test,6MWT)诱导低氧发生与否以及发生时间早晚,分为无运动性低氧(non-exercise induced desaturation,NEID)组、早期运动性低氧(early desaturation,ED)组、非早期运动性低氧(non-early desaturation,NED)组.比较三组间一般资料、肺功能及SpO2波动等相关指标的差异,采用广义估计方程分析发生ED的SpO2波动特点,多因素logistic回归分析发生ED的危险因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估预测价值.结果:与NEID组相比,ED组第一秒用力呼气容积(forced expiratory volume in the first second,FEV1)占预计值的百分比(FEV1％pred)更低,NED组并发肺气肿比例更高(均P<0.05).ED组运动期间平均血氧饱和度(SpO2mean)、最低血氧饱和度(SpO2min)、静息血氧饱和度(SpO2rest)与SpO2min的差值(∆SpO2)低于其他两组(均P<0.001).广义估计方程显示SpO2组间效应、时间效应、交互效应具有统计学意义(均P<0.001);ED组运动各个时间点SpO2均低于另两组(均P<0.001).以是否发生ED分为发生ED组及未发生ED组,行单因素logistic回归及多因素logistic回归分析,结果显示∆SpO2[OR=1.169;95％CI(1.011～1.352);P<0.05]是发生ED的危险因素,SpO2mean[OR=0.776;95％CI(0.637～0.947);P<0.05]是保护因素.ROC曲线中∆SpO2预测患者发生ED的曲线下面积(area under the curve,AUC)为0.829,灵敏度0.714,特异性0.785.结论:预出院发生ED的生活基本自理的慢阻肺患者运动期间低氧程度更明显,血氧波动更大.∆SpO2是ED发生的危险因素,且对发生ED具有预测价值,对临床个体化诊治具有指导意义.
Fluctuation of peripheral saturation oxygen and the risk factors for pre-discharge chronic obstructive pulmonary disease patients with early desaturation experienced
Objective To observe the saturation of peripheral oxygen(SpO2) fluctuation for early exer-cise induced desaturation in chronic obstructive pulmonary disease(COPD) patients ready for discharge and capable of basic self-care and analyze its risk factors.Methods A total of 142 COPD patients ready for discharge and capable of basic self-care,hospitalized in the Department of Pulmonary and Critical Care Medicine at the Second People's Hospital of Hefei,affiliated to Bengbu Medical Universi-ty,between May 2021 and May 2024,were selected.Based on whether exercise induced desaturation occurred during the 6-minute walk test(6MWT) and the timing of its onset,all patients were random-ly divided into a non-exercise induced desaturation(NEID) group,an early desaturation(ED) group,and a non-early desaturation(NED) group.The general data,lung function,and SpO2 fluctuation were compared among the three groups.Generalized estimating equation was used to analyze the SpO2 fluctu-ation for the occurrence of ED,and multivariable logistic regression was applied to analyze the risk factors for ED.Moreover,the receiver operating characteristic(ROC) curve was employed to evaluate the predictive value of these factors.Results Compared with the NEID group,the ED group had a low-er forced expiratory volume in the first second to the predicted value ratio(FEV1％pred),and the NED group had a higher proportion of patients complicated with emphysema(both P<0.05).During exercise,the ED group exhibited significantly lower mean SpO2(SpO2mean),minimum SpO2(SpO2min),the gap be-tween resting saturation of peripheral oxygen(SpO2rest)and SpO2min (∆SpO2) compared to the other two groups(P<0.001 for all).The generalized estimating equation showed that there were significant differ-ences in the inter-group effect,time effect,and interaction effect of SpO2 among the three groups(P<0.001 for all).Moreover,SpO2 values of ED group were significantly lower than the other two groups at all exercise time points(P<0.001 for all).Univariate and multivariate logistic regression analyses showed that ∆SpO2[OR=1.169;95％CI(1.011～1.352);P<0.05]was a risk factor for ED,while SpO2mean[OR=0.776;95％CI(0.637～0.947);P<0.05]was a protective factor.Meanwhile,the ROC curve for ∆SpO2 predicting ED had an area under the curve (AUC) of 0.829,with a sensitivity of 0.714 and a speci-ficity of 0.785.Conclusion COPD patients ready for discharge and capable of basic self-care show more pronounced desaturation during exercise and greater SpO2 fluctuations when early desaturation oc-curs.∆SpO2 is a risk factor for ED and has predictive value,which can be used for clinical diagno-sis and treatment.
pulmonary disease,chronic obstructiveexercise induced desaturation6-minute walk testearly desaturation
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