机械通气新生儿撤机失败的危险因素分析及预防对策探讨

Risk Factors Analysis and Explore the Preventive Countermeasures of Weaning Failure in Neonates with Mechanical Ventilation

目的:分析机械通气新生儿撤机失败的危险因素,并探讨预防对策。方法:回顾性选取2018年4月~2021年3月在我院接受机械通气治疗的256例新生儿的临床资料。根据是否发生撤机失败将患儿分为撤机成功组与撤机失败组。撤机失败的影响因素采用单因素及多因素Logistic回归分析,并探讨预防对策。结果:256例接受机械通气的新生儿中,有29例发生撤机失败,撤机失败率为11.33%。单因素分析结果显示:撤机成功组与撤机失败组在胎龄、出生体重、Apgar评分、产伤情况、呼吸机相关性肺炎、多脏器功能损害、肺部感染、败血症、营养支持、撤机时血氧分压(PO_(2))、撤机时心率、撤机时二氧化碳分压(PCO_(2))方面对比差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:撤机时PO_(2)偏低、撤机时心率较高、撤机时PCO_(2)较高、多脏器功能损害、无营养支持、伴有肺部感染、发生呼吸机相关性肺炎、胎龄<37周是导致机械通气新生儿撤机失败的危险因素(P<0.05)。结论:导致机械通气新生儿撤机失败的危险因素较多,临床应针对危险因素进行干预,并在撤机前进行充分评估以减少撤机失败率。

Objective:To analyze the risk factors of weaning failure of neonates with mechanical ventilation,and to explore the preventive countermeasures.Methods:The clinical data of 256 neonates who were treated with mechanical ventilation in our hospital from April 2018 to March 2021 were retrospectively selected.According to whether weaning failure occurred,the neonates were divided into weaning success group and weaning failure group.Logistic regression model was used to analyze the high risk factors of the weaning failure,and the preventive measures were explored.Results:Among 256 neonates who received mechanical ventilation,29 cases failed to wean,and the weaning failure rate was 11.33%.Univariate analysis showed that there were statistically significant differences between the weaning failure group and the weaning failure group in the fetal age,birth weight,Apgar score,birth injury,ventilator-associated pneumonia,multiple organ dysfunction,pulmonary infection,sepsis,nutritional support,partial pressure of blood oxygen(PO_(2))at weaning,heart rate at weaning and carbon dioxide partial pressure(PCO_(2))at weaning(P<0.05).Multivariate Logistic regression analysis showed that lower PO_(2)at weaning,higher heart rate at weaning,higher PCO_(2)at weaning,multiple organ dysfunction,no nutritional support,with pulmonary infection,with ventilater-associated pneumonia and gestational age<37 weeks were the risk factors for weaning failure in neonates with mechanical ventilation(P<0.05).Conclusion:There are many risk factors leading to weaning failure in neonates with mechanical ventilation.Clinical intervention should be carried out according to high risk factors,and full evaluation should be carried out before weaning to reduce the weaning failure rate.