早产儿呼吸机治疗的围生期高危因素分析

High risk factors of premature mechanical ventilation in perinatal period

目的：探讨早产儿需要持续正压通气（CPAP）和（或）气管插管呼吸机治疗的围生期高危因素。方法选取2009年11月至2013年6月出生、胎龄27～34周的403例早产儿进行研究。根据生后3 d内是否需要呼吸机支持治疗（＞48 h）分为观察组154例与对照组249例。收集20项可能与早产儿是否需要呼吸机支持治疗相关的围生期因素，应用χ2检验和Logistic回归进行影响因素分析。结果在预测需要CPAP和（或）气管插管治疗的多变量模型中，有统计学意义的因素为胎龄＜29周、出生体质量＜1000 g、母亲妊娠期糖耐量异常、母亲妊娠期重度高血压综合征、胎膜早破＞48 h、使用肺表面活性物质、频繁呼吸暂停、常规复苏后SaO2＜85％、重度三凹征、早期喂养胃潴留（P＜0.01或0.05）。结论综合分析胎龄、出生体质量低、使用肺表面活性物质、早产儿出生后早期出现频繁呼吸暂停、重度三凹征、常规复苏后SaO2低、早期喂养胃潴留、母亲妊娠期糖耐量异常、母亲妊娠期重度高血压疾病、胎膜早破这10项因素可以早期预测早产儿是否需要呼吸机支持治疗。

Objective To explore the high risk factors of premature mechanical ventilation in perinatal period. Methods A retrospective study of 403 preterm infants born from November 2009 to June 2013, gestational age 27-34 weeks was performed. Preterm infants were divided into observation group and control group,according to the application for mechanical ventilation during 3 days after birth. Twenty possible impact factors associated with mechanical ventilation support treatment in preterm infants were analyzed by Chi-squared test and Logistic regression. Results Ten significant factors in the multivariate model predicted the need for CPAP and （or）the treatment of tracheal intubation,which included gestational age 〈29 weeks,birth weight〈1 000 g,abnormal glucose tolerance during pregnancy,severe hypertension in pregnancy,premature rupture of membrane 〉2 days,pulmonary surfactant usage,frequent apnea,SaO2 after resuscitation 〈85%,severe three depressions and gastric residuals. Conclusions Comprehensive analysis of the above risk factors may be helpful for early prediction of ventilation support requirement in preterm infants.