早产儿有创机械通气初次撤机失败相关危险因素分析

Risk factors for the first ventilator weaning failure in preterm infants receiving invasive mechanical ventilation

目的研究早产儿有创机械通气初次撤机失败相关危险因素及不良预后。方法回顾性纳入北京大学第三医院新生儿重症监护室收治的生后72 h内有创机械通气的早产儿,根据初次撤机后72 h内是否需要再插管分为撤机成功组和撤机失败组,分析初次撤机失败相关危险因素及不良预后。结果共纳入282例早产儿,其中撤机失败组43例(15.2%)。撤机失败组胎龄、出生体重均低于撤机成功组(P<0.05),撤机失败组产房内插管率、动脉导管未闭(patent ductus arteriosus,PDA;内径≥2.5 mm)比例高于撤机成功组(P<0.05)。撤机前应用≥2种血管活性药物(OR=2.48,95%CI:1.22~5.03)、PDA (≥2.5 mm)(OR=4.54,95%CI:2.02~10.24)为撤机失败的危险因素(P<0.05)。撤机失败组患儿呼吸机相关性肺炎、中-重度支气管肺发育不良、败血症的发生率均高于撤机成功组(P<0.05),撤机失败组吸氧时间、住院时间长于撤机成功组(P<0.05)。结论撤机前使用≥2种血管活性药物、PDA (≥2.5 mm)是撤机失败的主要危险因素,撤机失败可能与住院早产儿不良结局有关。

Objective To study the risk factors for the first ventilator weaning failure and the relationship between the weaning failure and prognosis in preterm infants receiving invasive mechanical ventilation. Methods A retrospective analysis was performed for the preterm infants who were admitted to the Neonatal Intensive Care Unit of Peking University Third Hospital and received mechanical ventilation within 72 hours after birth. According to whether reintubation was required within 72 hours after the first weaning, the infants were divided into a successful weaning group and a failed weaning group. Results A total of 282 preterm infants were enrolled, and there were 43 infants(15.2%) in the failed weaning group. Compared with the successful weaning group, the failed weaning group had significantly lower gestational age and birth weight(P<0.05), a significantly higher rate of intubation in the delivery room(P<0.05), and a significantly higher proportion of infants with patent ductus arteriosus(PDA;diameter ≥2.5 mm)(P<0.05). Use of ≥2 vasoactive agents before ventilator weaning(OR=2.48, 95%CI: 1.22-5.03, P<0.05) and PDA(≥2.5 mm)(OR=4.54, 95%CI: 2.02-10.24, P<0.05) were risk factors for ventilator weaning failure. Compared with the successful weaning group, the failed weaning group had significantly higher incidence rates of ventilator-associated pneumonia, moderate-to-severe bronchopulmonary dysplasia, and sepsis(P<0.05). The oxygen inhalation time and hospital stay in the failed weaning group were significantly longer than those in the successful weaning group(P<0.05).Conclusions Use of ≥2 vasoactive agents before ventilator weaning and PDA(≥2.5 mm) are risk factors for ventilator weaning failure, and ventilator weaning failure may be associated with adverse outcomes in hospitalized preterm infants.