胎龄小于32周呼吸窘迫综合征早产儿有创机械通气拔管失败的危险因素分析

王越; 陈信; 张阵; 李如娜

doi:10.16766/j.cnki.issn.1674-4152.003802

胎龄小于32周呼吸窘迫综合征早产儿有创机械通气拔管失败的危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003802

蚌埠医科大学第一附属医院儿科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学研究重点项目 KJ2021A0800

蚌埠医学院临床研究专项 2022byflc009

详细信息

通讯作者:
陈信，E-mail: 44783939@qq.com

中图分类号: R722
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- 被引次数: 0
出版历程
- 收稿日期: 2024-05-11
- 网络出版日期: 2025-01-20

Risk factors of extubation failure in premature infants with respiratory distress syndrome born before 32 weeks of gestation

Department of Neonatology, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的通过研究气管插管机械通气呼吸窘迫综合征(RDS)早产儿的临床特征，分析拔管失败的危险因素及不良结局，为预防拔管失败提供参考依据。方法回顾统计蚌埠医科大学第一附属医院新生儿重症监护病房(NICU)2017年6月—2022年12月入院治疗的胎龄 < 32周早产儿临床资料，根据拔管结果分为成功组和失败组，分析失败组的危险因素，比较2组的病情发展与转归。结果共纳入RDS早产儿153例，成功组128例，失败组25例(16.3%)。进行logistic回归分析后发现，出生体重较低(OR=9.215，95% CI：1.153~73.611，P < 0.05)、5分钟Apgar评分低(OR=2.769，95% CI：1.681~4.563，P < 0.05)、未应用咖啡因(OR=46.353，95% CI：3.489~615.792，P < 0.05)、拔管前PaCO₂较高(OR=0.871，95% CI：0.809~0.938，P < 0.05)、拔管前PaO₂较低(OR=1.058，95% CI：1.018~1.101，P < 0.05)是拔管失败的危险因素。在拔管失败组中，患儿死亡抑或放弃治疗、呼吸机相关性肺炎(VAP)和支气管肺发育不良(BPD)均有较高发生率(P < 0.05)，且氧疗时间大于成功组(P < 0.05)。结论出生体重越低、5分钟Apgar评分越低、未应用咖啡因、较高的PaCO₂和较低的PaO₂是预测RDS早产儿拔管失败的危险因素，早产儿死亡及不良结局的风险会因拔管失败而增加。
- 气管插管 /
- 拔管失败 /
- 早产儿
Abstract: Objective To study the clinical characteristics of premature infants with respiratory distress syndrome (RDS) by tracheal intubation mechanical ventilation, analyze the risk factors and adverse outcomes of extubation failure, and provide evidence for its prevention. Methods The clinical data from preterm infants (< 32 weeks gestational age) admitted to Neonatal Intensive Care Unit (NICU) of the First Affiliated Hospital of Bengbu Medical University from June 2017 to December 2022 were reviewed and analyzed. According to the outcome of tracheal intubation and extubation, they were divided into a successful group and a failed group. The risk factors for extubation failure were analyzed, and the clinical progression and outcomes of the two groups were compared. Results A total of 153 premature infants with RDS were included, with 128 infants in the successful extubation group and 25 infants (16.3%) in the failed extubation group. Logistic regression analysis identified the following significant risk factors for extubation failure: low birth weight (OR=9.215, 95% CI: 1.153-73.611, P < 0.05), and low 5-minute Apgar score (OR=2.769, 95% CI: 1.681-4.563, P < 0.05), no caffeine use (OR=46.353, 95% CI: 3.489-615.792, P < 0.05), high PaCO₂ before extubation (OR=0.871, 95% CI: 0.809-0.938, P < 0.05), and low PaO₂ before extubation (OR=1.058, 95% CI: 1.018-1.101, P < 0.05). The rates of death or abandonment of treatment, ventilator-associated pneumonia (VAP), and bronchopulmonary dysplasia (BPD) were higher in the failed group (P < 0.05). Additionally, the failed group required longer oxygen therapy compared to the successful group (P < 0.05). Conclusion Lower birth weight, lower 5-minute Apgar score, no caffeine use, elevated PaCO₂, and reduced PaO₂ are significant predictors of extubation failure in premature infants with RDS. Extubation failure increases the risk of death and adverse outcomes in these infants.
- Tracheal intubation /
- Extubation failure /
- Preterm infant

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表 1 拔管失败组与成功组早产儿临床资料比较

Table 1. Comparison of clinical data of extremely premature infants in the failed extubation group and the successful extubation group

变量	成功组(n=128)	失败组(n=25)	统计量	P值
胎龄[M(P₂₅, P₇₅), 周]	30.3(29.3, 31.1)	29.1(28.1, 30.1)	-3.032^a	0.002
出生体重[M(P₂₅, P₇₅), g]	1 425(1 205, 1 750)	1 300(1 065, 1 450)	-2.623^a	0.009
性别(男/女，例)	78/50	15/10	0.008^b	0.930
SGA[例(%)]	22(17.2)	3(12.0)	0.412^b	0.521
剖宫产[例(%)]	74(57.8)	11(44.0)	1.616^b	0.204
母亲患妊娠糖尿病[例(%)]	12(9.4)	4(16.0)	0.400^b	0.527
母亲患妊娠期高血压疾病[例(%)]	26(20.3)	3(12.0)	0.477^b	0.490
胎膜早破[例(%)]	36(28.1)	10(20.0)	0.704^b	0.401
1 min Apgar评分[M(P₂₅, P₇₅)，分]	6(5，8)	6(5，8)	-0.306^a	0.760
5 min Apgar评分[M(P₂₅, P₇₅)，分]	9(8, 9)	8(7, 9)	-3.510^a	< 0.001
应用咖啡因[例(%)]	41(32.0)	3(12.0)	4.096^b	0.043
拔管前应用地塞米松[例(%)]	124(96.9)	23(92.0)	0.343^b	0.558
拔管时日龄[M(P₂₅, P₇₅), d]	4(2, 5)	4(3.5)	-0.923^a	0.356
PDA[例(%)]	17(13.3)	4(16.0)	0.002^b	0.965
PS应用≥2次[例(%)]	18(14.1)	6(24.0)	0.901^a	0.343
EOS[例(%)]	29(22.7)	8(32.0)	0.996^a	0.318
拔管前PaO₂[M(P₂₅, P₇₅), mmHg]	74(67, 84.75)	68(56.5, 77.5)	-2.041^b	0.041
拔管前PaCO₂[M(P₂₅, P₇₅), mmHg]	39(34, 45)	45(38，50.5)	-2.203^b	0.028
撤机后FiO₂ [M(P₂₅, P₇₅), %]	30(25, 30)	30(25, 30)	-1.052^b	0.293
HFOV[例(%)]	5(3.9)	2(8.0)	0.139^a	0.709
CMV[例(%)]	123 (96.1)	23(92.0)	0.139^a	0.709
注：^a为Z值，^b为χ²值。

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表 2 拔管失败相关因素logistic回归分析

Table 2. Logistic regression analysis of factors related to extubation failure

变量	B	SE	Waldχ²	P值	OR值(95% CI)
出生体重	2.221	1.060	4.388	0.036	9.215(1.153~73.611)
5 min Apgar评分	1.019	0.255	15.989	< 0.001	2.769(1.681~4.563)
咖啡因	3.836	1.320	8.450	0.004	46.353(3.489~615.792)
拔管前PaCO₂	-0.138	0.038	13.451	< 0.001	0.871(0.809~0.938)
拔管前PaO₂	0.057	0.020	8.041	0.005	1.058(1.018~1.101)

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表 3 拔管失败组与成功组早产儿预后比较

Table 3. Comparison of prognosis between the failed extubation group and the successful extubation group

组别	例数	死亡或放弃治疗 [例(%)]^a	气胸 [例(%)]	NEC [例(%)]	LOS [例(%)]	VAP [例(%)]	BPD [例(%)]	IVH [例(%)]	ROP [例(%)]	吸氧时间 [M(P₂₅, P₇₅), d]
成功组	126	2(1.6)	4(3.2)	17(13.5)	25(19.8)	9(7.1)	12(9.5)	37(29.4)	15(11.9)	19.0(14.0, 30.3)
失败组	21	4(16.0)	2(9.5)	3(14.3)	8(38.1)	6(28.6)	6(28.6)	10(47.6)	4(19.0)	35.0(21.5, 50.0)
统计量		8.056^b	0.586^b	< 0.001^b	2.476^b	6.833^b	4.434^b	2.758^b	0.305^b	-4.007^c
P值		0.005	0.444	>0.999	0.116	0.009	0.035	0.097	0.581	< 0.001
注：^a为拔管成功组128例，拔管失败组25例。^b为χ²值，^c为Z值。

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