目标：一系列质量控制（QC）目标（SpO2辛100％，PaCO240mmHg,提出了Pmean﹤10cmH2O），并在单个重症监护病房（ICU）环境中广泛使用。这项研究的目的是评估这些QC目标是否可以改善重症患者的预后。方法:收集北京协和医院重症医学科2013年5月-2017年5月入住ICU接受机械通气患者的实时临床资料并进行分析。结果：共有7,670例患者[平均年龄，58岁；3,943（51.5％）男性]分为QC前（n=3,936）和QC后（n=3,734）组。QC目标（SpO2，PaCO2和Pmean）和呼吸参数（FiO2％，PaO2,PEEP,潮气量,和呼吸频率）入住ICU后72小时内，主要结果（ICU死亡率，28-,60-,和90天死亡率)和次要结果(出院后，ICU入院天数,机械通气次数,和中心静脉压）在QC前后组之间进行测量和比较。Pmean的72小时平均值，FiO2%,QC组术后PaO2、VT显著低于QC组,PaCO2显著高于QC组(P<0.05)。90天死亡率较低，在医疗建议下减少出院，ICU住院天数减少,与前比较，QC组机械通气次数减少（P<0.05）。有趣的是,术后QC组CVP显著低于前QC组(P<0.05)。结论：QC目标（SpO2辛100％，PaCO240mmHg,Pmean﹤10cmH2O)有助于避免高氧水平的危害，防止肺损伤，改善循环功能，这导致危重病人的预后更好。
Objectives: A series of quality control (QC) targets (SpO2≠100%, PaCO2≮40 mmHg, Pmean≯10 cmH2O) was put forward and widely used in a single intensive care unit (ICU) setting. The aim of this study was to assess whether these QC targets could improve the outcomes of critically ill patients. Methods: The real-time clinical data of patients undergoing mechanical ventilation at ICU admission between May 2013 and May 2017 in the Department of Critical Care Medicine of Peking Union Medical College Hospital were collected and analyzed. Results: A total of 7,670 patients [mean age, 58 years; 3,943 (51.5%) male] were divided into the before QC (n = 3,936) and after QC (n = 3,734) groups. QC targets (SpO2, PaCO2, and Pmean) and respiratory parameters (FiO2%, PaO2, PEEP, tidal volume, and respiratory rate) within 72 h of ICU admission, primary outcomes (ICU mortality, 28-, 60-, and 90-day mortality) and secondary outcomes (discharge against medical advice, ICU admission days, mechanical ventilation times, and central venous pressure) were measured and compared between the before and after QC groups. The 72 h average of the Pmean, FiO2%, PaO2, and VT were significantly lower and PaCO2 was higher in the after QC than in the before QC group (P < 0.05). A lower 90-day mortality rate, less discharge against medical advice, fewer ICU admission days, and reduced mechanical ventilation times were found in the after QC group compared with the before QC group (P < 0.05). Interestingly, CVP was significantly lower in the after QC group than in the before QC group (P < 0.05). Conclusions: The QC targets (SpO2≠100%, PaCO2≮40 mmHg, Pmean≯10 cmH2O) contributed to avoiding high oxygen level hazards, protecting against lung injury, and improving circulatory function, which resulted in a better prognosis of critically ill patients.
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