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into an escalation group and a no⁃escalation group according to whether or not an oxygen therapy escalation event occurred within 48 h
of admission and the monitoring data of the two groups were analyzed. Correlations of finger pulse oximetry and pulse rate⁃related
parameters with inflammatory and immune factors were analyzed. Finger pulse oximetry monitoring data were also analyzed in the case
of a further oxygen therapy escalation event within 48 h after escalation to bilevel positive airway pressure（BiPAP）oxygen therapy.
The value of finger pulse oximetry in diagnosing early oxygen escalation events was explored using receiver operating characteristic
（ROC）curve. Results：①The ABG counts，the day of oxygen therapy initiation escalation and reaching the maximum parameters in
the continuous finger pulse oximetry monitoring group were less than those in the routine finger pulse oximetry monitoring group（P <
0.05）. Compared with the routine finger pulse oximetry monitoring group, the continuous finger pulse oximetry monitoring group had
higher PaO2/FiO2 and lower levels of IL⁃6 and CRP on day（7±1）of admission（P < 0.05）. ②The differences in monitoring parameters
in the continuous finger pulse oximetry monitoring group in terms of lowest SpO 2 （SpO2L），mean SpO2 （mSpO2），the percentage of time
with daily SpO2 below 86%，88%，90%，92% and 94%（T86，T88，T90，T92，and T94），and standard deviation of SpO 2 in 24 h between the
escalation group and no ⁃ escalation group were statistically significant（all P < 0.05）. IL ⁃ 6，CRP and immunoglobulin G were
significantly correlated with SpO 2 parameters. ③ Continuous monitoring parameters on BiPAP days in the continuous finger pulse
oximetry monitoring group showed events of sudden oxygen desaturation accompanied by increasing pulse rate. Such hypoxic events
were found to be associated with BiPAP offline. The difference in descending area（DA）of SpO2 desaturation was statistically
significant between the escalation and no⁃escalation groups. The ROC for DA diagnosis of escalation events of early oxygen therapy on
BiPAP respiratory support was 0.852（P < 0.05），suggesting that DA can be used as a predictor of oxygen therapy escalation events.
Conclusion：Continuous finger pulse oximetry monitoring parameter T 92 can identify the risk of progressive exacerbation of hypoxic
events at an early stage，which assist in the timely adjustment of oxygen therapy regimen. The DA of SpO 2 desaturation under BiPAP
daily offline can be used as a predictor of escalation events of oxygen therapy. Continuous finger pulse oximetry monitoring help guide
decisions about oxygen therapy regimens in pneumonia patients with hypoxemia.
［Key words］ pneumonia；hypoxia；pulse oximetry；oxygen inhalation therapy；pulse oxygen saturation
［J Nanjing Med Univ，2025，45（02）：173⁃184］

低氧血症是肺炎患者预后不佳和治疗失败的 指数预测 ICU 肺炎患者应用经鼻高流量湿化氧疗
高危因素 ［1 -2］ 。规范化氧疗可纠正低氧血症并减少 （high⁃flow nasal cannula oxygen therapy，HFNC）的可
与缺氧相关的并发症，可显著提升肺炎伴低氧血症 行性和治疗成功率 ［5-6］ 。但这些预测模型均聚焦于
患者的存活率。临床制定氧疗方案是一个复杂的 ICU患者，甚少有研究关注普通病房患者，且普通病房
过程，涉及对血氧状况和呼吸频率等生命体征趋势 通常不易获得这些预测模型的参数。普通病房与ICU
的评估以及医生对疾病的准确判断。出现低氧血 的不同之处在于后者拥有更高的护患比例（高达1∶1）
症的肺炎患者血氧波动较大，如未得到及时改善以 和更高级的监测技术。因此在普通病房间歇性的
维持机体氧合需求，病情可能进一步加重，严重者 生命体征监测下，医护人员容易忽视不良事件、缺
并发呼吸衰竭。但目前普通病房的氧疗疗效观察 乏临床紧迫性而减少预防性的治疗干预措施。研
方法不能持续床旁观察及分析患者的呼吸及血氧 究证明肺炎患者氧疗时的脉搏血氧饱和度（pulse
状态，从而影响氧疗方案的及时调整。 oxygen saturation，SpO2）水平与其死亡风险密切相关，
［7］
目前临床主要通过识别心肺生命体征来对患 对肺炎患者临床需要关注其脉氧变化趋势 。因而，
者进行病情分层并指导治疗，但对患者来说更有价 本研究探讨持续指脉氧监测对普通病房肺炎患者的
值的是能提前预测不良事件，并指导早期干预措 氧疗价值，并试图寻找能识别早期氧疗升级事件的脉
施。已有诸多预测模型，如Póvoa等 开发连续检测 氧参数，以便应用于普通病房并及时调整氧疗方案。
［3］
C 反应蛋白（C⁃reactive protein，CRP）来预测机械通
1 对象和方法
［4］
气患者呼吸机相关性肺炎的发展；Politano等 分析
重症监护病房（intensive care unit，ICU）患者的生命 1.1 对象
体征数据和波形来构建早期呼吸失代偿的模型，并 选取 2022 年 12 月—2023 年 3 月于南京医科大
用呼吸速率⁃氧合（respiration rate⁃oxygenation，ROX） 学第一附属医院呼吸与危重症医学科普通病房住