儿童脊髓性肌萎缩并肺炎气道拔管危险因素分析

Risk factors of tracheal extubation failure in children with spinal muscular atrophy combined with pneumonia

目的探讨脊髓性肌萎缩并肺炎气管插管患儿气道拔管的相关危险因素。方法回顾性分析2018年8月至2021年12月于首都儿科研究所附属儿童医院住院的34例脊髓性肌萎缩并肺炎气管插管患儿的临床资料,按成功拔管与否分为成功组及失败组。采用Mann-Whitney U检验及χ^(2)检验比较两组可能影响拔管成功性的相关危险因素的差异,并进行多因素Logistic回归分析。结果34例患儿中男14例、女20例,就诊年龄10.8(6.0,25.2)月龄,1型31例,2型3例。11例在插管前为被动进食,22例在治疗中使用了气道清理术,28例存在肺部混合病原感染。成功组21例、失败组13例。失败组插管时最高动脉二氧化碳分压、拔管前胸部影像为实变者比例均高于成功组[81(49,86)比48(43,56)mmHg(1 mmHg=0.133 kPa)、6/13比10%(2/21),Z=-2.55、χ^(2)=5.99,均P<0.05]。多因素Logistic回归分析显示插管前被动进食(OR=39.88,95%CI 3.36~473.29,P=0.003)、未使用气道清理术(OR=14.55,95%CI 1.35~156.78,P=0.027)是拔管失败的独立危险因素。结论影响脊髓性肌萎缩并肺炎气管插管患儿气道拔管的独立危险因素为插管前被动进食及未使用气道清理术,故插管前患儿能自主进食,使用气道清理术以改善通气及使胸部影像尽量清晰可提高拔管成功性。

Objective To summarize the risk factors of tracheal extubation failure in children with spinal muscular atrophy(SMA)combined with pneumonia.Methods In this retrospective study,clinical data of 34 children with SMA combined with pneumonia who were hospitalized in Children's Hospital Affiliated to Capital Institute of Pediatrics from August 2018 to December 2021 were analyzed.According to whether the extubation was successful or not,they were divided into the success group and the failure group.The risk factors that may affect the success of extubation between two groups were derived by comparing the clinical characteristics by Mann-Whitney U test and Chi-square test,followed by multivariate Logistic regression.Results Among the 34 cases,there were 14 males and 20 females,aged 10.8(6.0,25.2)months at the time of hospitalization,31 cases were type 1 SMA and 3 cases were type 2.Eleven children were unable to eat independently before intubation,22 were treated with airway clearance techniques and 28 had multiple pulmonary infections.There were 21 cases in the success group and 13 cases in the failure group.The failure group had higher maximum partial pressure of arterial carbon dioxide level during intubation and higher rate of consolidation changes in chest images before extubation(81(49,86)vs.48(43,56)mmHg(1 mmHg=0.133 kPa),6/13 vs.10%(2/21),Z=-2.55,χ^(2)=5.99,both P<0.05).Multivariate Logistic regression analysis showed that tube feeding before intubation(OR=39.88,95%CI 3.36-473.29,P=0.003)and not receiving airway clearance therapy(OR=14.55,95%CI 1.35-156.78,P=0.027)were independent risk factors for extubation failure.Conclusions The independent risk factors of tracheal extubation failure in children with SMA combined with pneumonia are unable to eat independently before intubation and not receiving airway clearance therapy.Therefore,the conditions to improve the success of extubation consist of having the ability to eat independently before intubation,using airway clearance techniques to improve ventilation and to make the chest images as clear as possible.