小儿重症肺炎经鼻高流量加温湿化氧疗撤机失败的危险因素分析

Analysis of risk factors for failure of high-flow nasal cannula oxygen therapy for severe pneumonia in children

目的探讨小儿重症肺炎经鼻高流量加温湿化氧疗(HFNC)撤机失败的危险因素。方法回顾性分析2019年1月—2020年2月入住漳州市医院儿童重症监护室(PICU)的118例小儿重症肺炎使用HFNC者的临床资料,根据HFNC是否成功撤离分为成功组(n=80)和失败组(n=38)。比较两组患儿的一般资料、动脉血气指标、基础病发生率、并发症发生率,采用多因素Logistic回归分析小儿重症肺炎HFNC撤机失败的危险因素。结果118例小儿重症肺炎使用HFNC撤机失败的占比为32.20%。失败组患儿的总住院时间以及入住PICU时间均长于成功组,差异有统计学意义(P<0.05);失败组患儿的白细胞、二氧化碳分压高于成功组,氧合指数低于成功组,差异有统计学意义(P<0.05);失败组存在心脏病、营养不良、早产儿等基础病的比例高于成功组,差异有统计学意义(P<0.05);失败组患儿并发心力衰竭、呼吸机相关肺炎的比例高于成功组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,合并心力衰竭(β=1.639,OR=5.148,95%CI:1.424~18.611)、早产儿(β=1.229,OR=3.418,95%CI:0.535~21.846)、总住院时间长(β=0.164,OR=1.178,95%CI=1.039~1.336)是HFNC失败的危险因素(P<0.05),入院时氧合指数高(β=-0.015,OR=0.985,95%CI:0.975~0.996)是HFNC撤机失败的保护因素(P<0.05)。结论HFNC可以用于PICU小儿重症肺炎的治疗,但是存在失败病例,存在基础病(如早产儿或合并有心力衰竭)是HFNC撤机失败的高危因素,会增加总住院时间,入院时可通过相关病史及临床表现,结合血气及氧合指数,综合分析并进行初步判断,选择正确的呼吸支持模式,使患儿得到更好的治疗。

Objective To explore the risk factors for failure of high-flow nasal cannula oxygen therapy(HFNC)for severe pneumonia in children.Methods A total of 118 children with severe pneumonia treated with HFNC admitted to the Pediatric Intensive Care Unit(PICU)of Zhangzhou Hospital Affiliated to Fujian Medical University from January 2019 to February 2020 were retrospective analyzed.They were divided into success group(n=80)and failure group(n=38)according to whether HFNC was successfully withdrawn.The general data,arterial blood gas indexes,incidence of basic diseases and incidence of complications of the two groups were compared.Multivariate Logistic regression was used to analyze the risk factors of HFNC withdrawal failure in children with severe pneumonia.Results The failure rate of HFNC was 32.20%in 118 children with severe pneumonia.The total hospital stay and PICU stay in the failure group were longer than those in the successful group,the differences were statistically significant(P<0.05).The white blood cell and partial pressure of carbon dioxide in the failed group were higher than those in the successful group,and the oxygenation index was lower than that in the successful group,the differences were statistically significant(P<0.05).The proportions of heart disease,malnutrition,premature infant and other basic diseases in the failure group were higher than those in the success group,the differences were statistically significant(P<0.05).The proportions of complicated heart failure and ventilator-associated pneumonia in the failure group were higher than those in the successful group,and the differences were statistically significant(P<0.05).The results of multivariate Logistic regression analysis indicated that combined heart failure(β=1.639,OR=5.148,95%CI=1.424-18.611),preterm infants(β=1.229,OR=3.418,95%CI=0.535-21.846)and long total hospital stay(β=0.164,OR=1.178,95%CI=1.039-1.336)were risk factors for fail ure of HFNC(P<0.05).High oxygenation index on admission(β=-0.015,OR=0.985,95%CI=0.975-0.996)was the protective factors for HFNC failure(P<0.05).Conclusion HFNC can be used for the treatment of severe pneumonia in children with pediatric intensive care unit,but cases of failure still exist.For children with underlying diseases such as premature infants or combined with heart failure,it is a high-risk factor for HFNC withdrawal failure,and will increase the total hospital stay.At admission,a preliminary judgment can be made by comprehensive analysis of related medical history and clinical manifestations,combined with blood gas and oxygenation index,and then select the appropriate respiratory support mode,so that the children can get better treatment.