晚期早产儿和足月儿呼吸窘迫综合征并发气胸临床危险因素分析及预测模型建立

Analysis on clinical risk factors of respiratory distress syndrome complicated with aerothorax in late preterm infants and term infants and the establishment of prediction model

目的 观察研究晚期早产儿和足月儿呼吸窘迫综合征(RDS)并发气胸可能的临床危险因素及预测模型建立。方法 对2018年1月—2021年5月在丽水市人民医院新生儿科治疗诊断为晚期早产儿和足月儿RDS并发气胸30例患儿(作为观察组)和未并发气胸的75例患儿(作为对照组)进行回顾性分析。采用单因素分析、logistic回归分析、受试者工作特征曲线(ROC)及联合预测的截断值及ROC下面积(AUC),筛选出并发气胸的危险因素,预测并发气胸的风险模型。结果 单因素分析显示试管婴儿、肺表面活性物质(PS)使用剂量、PS使用时间、开始机械通气时间4个指标组间差异均有统计学意义(P<0.05)。logistic回归分析结果显示试管婴儿(OR=6.839)、PS使用时间>12h(OR=8.399)、开始机械通气时间>12h(OR=9.382)为晚期早产儿和足月儿RDS并发气胸的危险因素,PS使用剂量200mg/kg(OR=0.102)为保护因素。最佳的预测气胸发生模型为试管婴儿+PS使用剂量+开始机械通气时间或试管婴儿+PS使用时间+开始机械通气时间3指标模型。结论 试管婴儿、PS延迟使用及剂量不足、机械通气延迟使用是导致晚期早产儿或足月儿并发气胸的高危因素,应做到早发现、早诊断及早治疗,以避免气胸的发生。

Objective The observe and research the clinical risk factors of respiratory distress syndrome(RDS) complicated with aerothorax in late preterm infants and term infants and the establishment of prediction model. Methods From January 2018 to May 2021, 30 late preterm infants and term infants with RDS complicated with aerothorax(observation group) and 75 late preterm infants and term infants with RDS(control group) treated in Department of Neonatology, Lishui People’s Hospital were analyzed retrospectively. Univariate analysis, logistic regression analysis, receiver operating characteristic(ROC) curve, and collaborative prediction, and the area under ROC curve were used to screen the risk factors of RDS complicated with aerothorax, risk prediction mode was established. Results Univariate analysis showed that there were statistically significant differences in test tube baby, usage dose and time of pulmonary surfactant(PS), and beginning time of mechanical ventilation between the two groups(P<0.05). Logistic regression analysis showed that test tube baby(OR=6.839), usage dose of PS more than 12 hours(OR=8.399), and beginning time of mechanical ventilation more than 12 hours(OR=9.382) were risk factors of RDS complicated with aerothorax, PS dose 200 mg/kg(OR=0.102) was the protective factor. The optimal prediction model was test tube baby+usage dose of PS+beginning time of mechanical ventilation or test tube baby+usage time of PS+beginning time of mechanical ventilation. Conclusion Test tube baby, delayed usage of PS or underdosage, and delayed mechanical ventilation are high-risk factors of RDS complicated with aerothorax in late preterm infants and term infants, early detection, early diagnosis, and early treatment can avoid the occurrence of aerothorax.