The Early Warning Effect Of Serum Amyloid A And Oxygenation Index Monitoring In Severe Pneumonia Combined With Respiratory Failure

Objective: Clinically,early assisted respiratory support is often used for severe pneumonia patients with respiratory failure,which can quickly and efficiently improve the ventilation and ventilation function of patients,so as to quickly relieve the disease.In this study,we can effectively warn and evaluate the efficacy of severe pneumonia combined with respiratory failure and the influencing factors of clinical outcome under different respiratory support methods.Methods: Sixty-one patients,who went to the First Affiliated Ho spital of Hebei North University from June 2021 to December 2022,were diagnosed with severe pneumonia and respiratory failure,31 we re heated and wet high-flow nasal catheter ventilation（HHFNC）and30 were noninvasive ventilation（NIV）.Both groups used convention al anti-infection to relieve airway spasm,reduce phlegm,suppress air way inflammation,and correct electrolyte balance.All enrolled patient s were counted for age,gender,the main clinical manifestations（feve r,cough,expectoration,wheeze,and dyspnea）,the combined underlyi ng diseases（hypertension,diabetes mellitus,coronary heart disease,c hronic obstructive pulmonary disease,cerebrovascular disease,lung ca ncer）,and the partial pressure of carbon dioxide in artery（PaCO₂）,pa rtial pressure of oxygen in artery（PO₂）,OI,neutrophil-to-lymphocyte ra tio（NLR）,SAA,interleukin-6（IL-6）and procalcitonin（PCT）before a nd after 48 hours of treatment effect,and the lactate clearance rate（LCR）was calculated.SPSS25.0 was used to analyse the changes in these indicators.Results:1.The baseline clinical data of the two groups were not statistically significant（P>0.05）.2.There was no significant difference in PaCO₂,NLR,PaO₂,OI,LCR,PCT,IL-6 and SAA between 2 groups on admission（P>0.05）.3.After 48 hours of treatment,the OI of the HHFNC patients increased significantly than the NIV group was statistically significant（P <0.05）.The PaO₂ increased in both groups,It was statistically significant（P<0.05）.In the difference of 48 h of treatment,the difference of HHFNC patients showed greater OI D-value compared with the NIV group,it was statistically significant（P<0.05）.For the other indicators,the differences between the two groups were not statistically significant（P>0.05）.4.Comparison showed that PaO₂ and OI were significantly higher in the HHFNC group than before treatment,and PCT and NLR were significantly lower and statistically significantly different before and after treatment（P<0.05）;PaO₂ was significantly higher in the NIV group,and IL-6 and NLR were significantly lower,and the results were statistically significant（P<0.05）.5.No adverse reactions occurred within 48 hours in the HHFNC patients,and 6 patients（19.4%）in the NIV group had adverse reactions,which was significantly more than in the HHFNC group,and the difference was statistically significant（P< 0.05）.6.The difference in effect between the two groups after 48 hours in hospital was not statistically significant（P>0.05）.After comparison,the mortality rate was 30% and 35.5% in the HHFNC and NIV groups,and HHFNC was slightly lower than NIV,but not significantly different（P>0.05）.7.Statistical data using a multivariate Logistic model,excluding some confounding factors,we found that SAA and-OI were independent risk factors for the clinical outcome of SP with respiratory failure（P<0.05）.The area under the ROC curve of the SAA D-value for SP combined with respiratory failure was 0.954,with a sensitivity of 0.950 and a specificity of0.878.The range of the-OI D-value under the ROC curve for warning of SP combined with respiratory failure was 0.898,with a sensitivity of 0.850 and specificity of 0.902;both fit the model better.The area under the ROC curve for the SAA D-combined with the-OI D-value for early warning of SP combined with respiratory failure was 0.973,with a sensitivity of 0.900 and a specificity of 0.927.Conclusion:1.SAA difference and-OI difference are the main risk factors for SP warning of patients with respiratory failure.2.Early SAA combined with OI monitoring can be used as an important auxiliary index to judge the clinical outcome of adult severe pneumonia with respiratory failure,and provide basic data for further optimizing the clinical outcome evaluation scheme of adult severe pneumonia with respiratory failure.3.Patients with severe pneumonia and respiratory failure should use oxygen as early as possible.For patients with 150 mm Hg≤ OI <200mm Hg,HHFNC and NIV can be the initial options for respiratory support therapy.This study concluded that HHFNC showed better improvement in oxygenation status,less adverse effects and better dependence.