足月儿和近足月儿呼吸窘迫综合征需重复应用肺表面活性物质的高危因素分析

Analysis of the risk factors for repeated use of pulmonary surfactant in term and near term infants with respiratory distress syndrome

目的总结足月儿和近足月儿呼吸窘迫综合征（RDS）重复运用肺表面活性物质（Ps）的高危因素。方法选择本院于2015年2月至2016年9月收治的RDS患儿共130例为对象。根据患儿PS运用次数，分为单次组（使用1次）76例和重复组（使用次数≥2次）54例。比较两组患儿治疗总有效率，并对患儿出生时窒息率、RDS严重程度、首次PS治疗时间等潜在高危因素进行单因素分析和Logistic回归分析。结果单次组治疗总有效率为97．37％（74／76），显著高于重复组的治疗总有效率88．89％（48／54），差异有统计学意义（χ^2=3．931，P〈0．05）。单因素分析结果表明：出生时窒息、RDSⅢ-Ⅳ级、妊娠期高血压、PS前PaO2/FiO2、首次PS时间、呼吸支持时间、肺部感染、肺出血、PDA、休克、败血症、气胸是RDS患儿重复运用PS的危险因素（χ^2=6．512、5．326、4．323、4．165、4．269、4．081、4．578、5．772、6．096、19．594、8．100、4．300，P〈0．05）。Logistic多因素回归分析表明：出生时窒息、RDSⅢ-Ⅳ级、首次Ps时间、肺部感染和PDA是患儿重复使用Ps的独立危险因素（OR=1．267-20．453、2．862-4．679、1．095-1．234、0．117-0．542、2．467-169．263，P〈0．05）。结论多种因素可能诱发RDS患儿重复使用Ps。宜根据患儿临床特征和高危因素，提前预防和治疗，以改善治疗效果。

Objective To summarize the risk factors for repeated use of pulmonary surfactant （PS） in term and near term infants with respiratory distress syndrome （RDS）. Methods 130 cases of neonate with RDS treated in our hospital from February 2015 to September 2016 were enrolled. According to the frequency of PS use, 130 infants were divided into single group （using 1 time） 76 cases and repeating group （using frequency〉 2 doses） 54 cases. The total effective rate was compared, and the potential risk factors such as the rate of asphyxia, the severity of RDS, the time of first PS treatment were analyzed by the single factor analysis and the Logistic regression analysis. Results The total effective rate of the single group was 97.37% （74/76）, which was significantly higher than 88.89% （48/54） of the repeating group （χ^2=3.931, P〈0.05）. Univariate analysis showed that： birth asphyxia, RDS Ⅲ-Ⅳ grade, gestational hypertension, PaO2/FiO2 before PS, the time of first PS treatment, ventilation time, pulmonary infection, pulmonary hemorrhage, PDA, shock, sepsis, and pneumothorax were the risk factors of repeated use of PS （χ^2=6.512, 5.326, 4.323, 4.165, 4.269, 4.081, 4.578, 5.772, 6.096, 19.594, 8.100, 4.300, P〈0.05）. Logistic regression analysis showed that： birth asphyxia, RDS Ⅲ-Ⅳ grade, the time of first PS treatment, pulmonary infection, and PDA were independent risk factors of repeated use of PS （OR=1.267-20.453, 2.862-4.679, 1.095-1.234, 0.117-0.542, 2.467-169.263, P〈0.05）. Conclusion Multiple factors may induce re-use of PS in children with RDS. Advance prevention and treatment could improve the treatment effect according to the clinical characteristics and risk factors.