早产儿加温湿化高流量经鼻导管通气初始呼吸支持失败的危险因素分析

Risk factors for treatment failure of heated humidified high-flow nasal cannula as initial respiratory support for preterm infants

目的分析早产儿加温湿化高流量鼻导管通气(heated humidifiedhigh-flow nasalcannula,HHHFNC)初始呼吸支持失败的危险因素。方法回顾性收集2018年1月至2021年4月收治的生后使用HHHFNC初始呼吸支持的早产儿病例资料,根据治疗后72 h内是否需升级为无创持续气道正压通气或有创机械通气,分为呼吸支持失败组和成功组,采用单因素分析与多因素logistic回归分析HHHFNC呼吸支持失败的危险因素。结果共纳入166例早产儿,HHHFNC呼吸支持失败48例(28.9%)。单因素分析结果显示:呼吸支持失败组胎龄、出生体重均低于成功组(n=118),吸入氧浓度>35%、流量>6 L/min、发生动脉导管未闭(patent ductusarteriosus,PDA)、诊断新生儿呼吸窘迫综合征(respiratory distresssyndrome,RDS)、使用肺表面活性物质治疗比例均高于成功组(P<0.05)。多因素logistic回归分析显示:胎龄<32周、PDA>1.5 mm且左心房∶主动脉内径>1.4、吸入氧浓度>35%、流量>6 L/min、RDS是HHHFNC初始呼吸支持失败的危险因素(P<0.05)。结论当早产儿胎龄<32周,或有RDS时,早产儿HHHFNC初始呼吸支持失败的风险高;在HHHFNC初始呼吸支持治疗中,当氧浓度>35%和/或流量>6 L/min,或出现PDA时,呼吸支持失败的风险增大,应积极考虑升级呼吸支持方式。

Objective To study the risk factors for treatment failure of heated humidified high-flow nasal cannula(HHHFNC)as initial respiratory support for preterm infants.Methods A retrospective analysis was performed on the medical data of the preterm infants who were admitted from January 2018 to April 2021 and received HHHFNC for initial respiratory support after birth.According to whether it was necessary to upgrade to noninvasive continuous positive airway pressure or invasive mechanical ventilation within 72 hours after treatment,they were divided into a failure group and a success group.Univariate and multivariate logistic regression analyses were used to determine the risk factors for failure of HHHFNC as initial respiratory support.Results A total of 166 preterm infants were included,among whom 48(28.9%)experienced the treatment failure of HHHNFC as initial respiratory support.The univariate analysis showed that compared with the success group with 118 infants,the failure group had significantly lower gestational age and birth weight and a significantly higher proportion of infants with fraction of inspired oxygen>35%,flow rate>6 L/minute,patent ductus arteriosus(PDA),respiratory distress syndrome(RDS),or use of pulmonary surfactant(P<0.05).The multivariate logistic regression analysis showed that gestational age<32 weeks,PDA(>1.5 mm and left atrium/aorta diameter ratio>1.4),fraction of inspired oxygen>35%,flow rate>6 L/minute,and presence of RDS were risk factors for the treatment failure of HHHNFC as initial respiratory support(P<0.05).Conclusions The preterm infants with a gestational age of<32 weeks or the presence of RDS tend to have a high risk of failure of HHHNFC as initial respiratory support.The risk of failure of HHHFNC as initial respiratory support increases in infants with oxygen concentration>35%and/or flow rate>6 L/minute,or the presence of PDA,suggesting an upgrade of respiratory support should be considered.