胎龄28～34周早产儿呼吸窘迫综合征INSURE策略失败的高危因素分析

Risk factors for intubation-surfactant-extubation failure in preterm infants with gestational age of 28-34 weeks with respiratory distress syndrome

目的探讨胎龄28～34周早产儿呼吸窘迫综合征(NRDS) INSURE策略失败的高危因素。方法以收治的NRDS早产儿90例为研究对象,应用INSURE策略治疗,根据INSURE策略的成败,分为成功组和失败组。回顾性分析两组患儿的临床资料。结果失败组27例(30%)、成功组63例(70%)。失败组男性比例、剖宫产率明显高于成功组;而胎龄、出生体重则明显低于成功组,差异有统计学意义(P <0. 05)。失败组母患妊娠期糖尿病的比例明显高于成功组,差异有统计学意义(P <0. 05)。应用肺表面活性物质(PS)前,失败组动脉血氧分压(PaO_2)、动脉血氧分压及吸入氧浓度比值(PaO_2/FiO_2)均低于成功组;而动脉血二氧化碳分压(PaCO_2)则高于成功组,差异有统计学意义(P <0. 05)。失败组早产儿视网膜病变(ROP)、颅内出血(ICH)发生率高于成功组(P <0. 05);而气胸(PNX)、新生儿坏死性小肠结肠炎(NEC)、支气管肺发育不良(BPD)发生率,两组比较差异无统计学意义(P> 0. 05)。失败组吸氧时间、住院时间高于成功组,差异有统计学意义(P <0. 05)。多因素logistic回归分析,出生体重<1 500 g、PS应用前血气分析PaCO_2> 55 mm Hg、PaO_2/FiO_2<185是INSURE策略失败的独立危险因素。结论应用INSURE策略治疗NRDS失败的独立高危因素包括低出生体重、高PaCO_2及低PaO_2/FIO_2。临床工作中应综合分析NRDS患儿存在的各项高危因素,为NRDS患儿选择合适的早期呼吸支持模式。

Objective To assess the risk factors of intubation-surfactant-extubation(INSURE) failure in preterm infants(gestational age of 28-34 weeks) with respiratory distress syndrome(NRDS).Methods The clinical data of 90 preterm infants with NRDS treated by INSURE technique were retrospectively analyzed from Mar.2016 to Feb.2018.According to whether the reintubation was performed,the infants were divided into success group and failure group.Results The INSURE failure rate was 30.0%.Comparing with success group,the male ratio and cesarean section rate in failure group were significantly higher,but the gestation age and birth weight were significantly lower(P < 0.05).The ratio of maternal gestational diabetes mellitus(GDM) in failure group was significantly higher(P < 0.05).Before pulmonary surfactant(PS) treatment,the PaO2 and PaO2/FiO2 levels in the failure group were significantly lower,but the Pa CO2 level was significantly higher than those in the success group(P < 0.05).Comparing with success group,the incidences of retinopathy of prematurity(ROP) and intracranial hemorrhage(ICH),the total time on using oxygen and hospitalization were significantly higher(P < 0.05).No significant difference was found between the two groups in pneumothorax(PNX),neonatal necrotizing enterocolitis(NEC) or bronchopulmonary dysplasia(BPD).The multifactor logistic regression analysis showed that the birth weight < 1 500 g,Pa CO2> 55 mm Hg and PaO2/FiO2< 185 were independent risk factors for INSURE failure.Conclusion Low birth weight,high Pa CO2 and low PaO2/FiO2 are the risk factors for INSURE failure in preterm infants with NRDS.