Pierre Robin序列征婴儿下颌骨牵引术后撤机失败的危险因素

Risk factors for weaning failure after mandibular distraction osteogenesis in infants with Pierre Robin sequence

目的筛选Pierre Robin序列征婴儿下颌骨牵引术后撤机失败的危险因素。方法采用回顾性队列研究方法,收集2016年11月至2019年5月择期全麻下行下颌骨牵引成骨术患儿的病历资料,纳入标准:年龄<1岁;无严重心肺疾病和严重气道畸形。收集患儿性别、年龄、体重、是否早产、是否低出生体重、是否进行术前气管插管、是否存在术前肺部感染、是否发生术后呼吸机相关性肺炎、首次撤机时机械通气时间和牵引长度。根据是否发生术后首次撤机失败分为2组:撤机成功组和撤机失败组。将组间比较差异有统计学意义的因素进行logistic回归分析,筛选术后撤机失败的危险因素。结果最终共纳入140例,其中9例患儿发生术后首次撤机失败,发生率为6.4%。logistic回归分析显示,撤机时牵引长度和呼吸机相关性肺炎是术后撤机失败的独立危险因素(P<0.05)。结论撤机时牵引长度和呼吸机相关性肺炎是Pierre Robin序列征婴儿下颌骨牵引术后撤机失败的独立危险因素。

Objective To identify the risk factors for weaning failure after mandibular distraction osteogenesis in the infants with Pierre Robin sequence.Methods A retrospective cohort study was conducted to collect clinical records of infants with Pierre Robin sequence underwent mandibular distraction osteogenesis at Guangzhou Women and Children′s Medical Center from November 2016 to May 2019.The inclusion criteria consisted of the following:age<1 yr and no serious cardiopulmonary disease or serious airway malformation.The medical charts were reviewed for sex,age,weight,premature delivery,low birth weight,preoperative intubation,preoperative pulmonary infection,ventilator-associated pneumonia,as well as mechanical ventilation time and distraction length at first weaning.The infants were divided into 2 groups according to the outcome of ventilator weaning at first attempt:successful group and failure group.The risk factors of which P values were less than 0.05 would enter the logistic regression analysis to stratify weaning failure-related risk factors.Results A total of 140 infants were included in this study,of which 9 cases developed failure of weaning at first attempt after operation,with the incidence of 6.4%.The results of logistic regression analysis showed that the distraction length and incidence of ventilator-associated pneumonia were independent risk factors for weaning failure after operation(P<0.05).Conclusion The length of distraction and ventilator-associated pneumonia are independent risk factors for weaning failure after mandibular distraction osteogenesis in the infants with Pierre Robin sequence.