极低出生体重儿呼吸窘迫综合征无创高频振荡通气初始治疗失败危险因素分析

Risk factors for failure of nasal high frequency oscillatory ventilation as initial therapy in very low birth weight infants with respiratory distress syndrome

目的探讨无创高频振荡通气(nasal high frequency oscillatory ventilation,NHFOV)初始治疗极低出生体重儿呼吸窘迫综合征失败的危险因素。方法回顾性分析2018年1月至2021年12月广东省妇幼保健院出生并收入新生儿重症监护室(neonatal intensive care unit,NICU)、诊断为呼吸窘迫综合征且以NHFOV为初始通气方式的极低出生体重儿病例资料,根据初始治疗效果分为成功组和失败组,比较两组患儿基本情况及转归,并通过二元logistic回归分析NHFOV初始治疗失败的危险因素。结果共纳入135例,成功组103例,失败组32例,NHFOV初始治疗失败率23.7%。失败组患儿入NICU第1次血气分析pH(7.26±0.09比7.33±0.08)、PaO_(2)[61.0(49.6,77.2)mmHg比83.6(64.4,99.0)mmHg]低于成功组(P<0.05),PaCO_(2)[49.0(42.3,58.1)mmHg比43.4(36.0,50.0)mmHg]高于成功组(P<0.05)。PaCO_(2)预测NHFOV初始治疗失败的受试者工作特征曲线的曲线下面积为0.682(95%CI 0.575~0.788),截断值为44.8 mmHg;PaO_(2)预测NHFOV初始治疗成功的曲线下面积为0.716(95%CI 0.615~0.817),截断值为67.1 mmHg。失败组早发型败血症、生后3 d内休克、有血流动力学意义的动脉导管未闭发生率均高于成功组(分别为40.6%比7.8%、53.1%比2.9%、31.3%比13.6%),差异有统计学意义(P<0.05)。二元logistic回归分析显示,入NICU第1次血气分析PaO_(2)<67.1 mmHg(OR=5.458,95%CI 1.730~17.220)及生后3 d内休克(OR=26.585,95%CI 3.854~183.396)是NHFOV初始治疗失败的独立危险因素(P<0.05)。结论NHFOV初始治疗失败与极低出生体重儿入NICU第1次血气分析结果、早发型败血症、有血流动力学意义的动脉导管未闭及生后3 d内休克等因素有关,其中PaO_(2)<67.1 mmHg、生后3 d内休克是NHFOV初始治疗失败的独立危险因素。

Objective To study the risk factors of failure using nasal high frequency oscillatory ventilation(nHFOV)as initial therapy in the treatment of respiratory distress syndrome(RDS)in very low birth weight infants(VLBWIs).Methods From January 2018 to December 2021,VLBWIs with RDS initially supported by nHFOV in NICU of our hospital were retrospectively analyzed.They were assigned into success and failure groups according to the ventilation efficacy.Demographic data and clinical outcomes of the two groups were compared.Risk factors of initial nHFOV failure were analyzed using binary Logistic regression method.Results A total of 135 infants were included,including 103 in the success group and 32 in the failure group.The initial nHFOV failure rate was 23.7%.The failure group had lower pH(7.26±0.09 vs.7.33±0.08)and PaO_(2)[61.0(49.6,77.2)mmHg vs.83.6(64.4,99.0)mmHg]than the success group(P<0.05)and higher PaCO_(2) than the success group[49.0(42.3,58.1)mmHg vs.43.4(36.0,50.0)mmHg](P<0.05).Using PaCO_(2) as predictor,the area under the curve(AUC)was 0.682(95%CI 0.575-0.788)and the cut-off value was 44.8 mmHg for nHFOV failure and the AUC was 0.716(95%CI 0.615-0.817)and the cut-off value was 67.1 mmHg for nHFOV success.The incidences of early onset sepsis(EOS),shock within 3 d and hemodynamically significant patent ductus arteriosus(hsPDA)in the failure group were significantly higher than the success group(40.6%vs.7.8%,53.1%vs.2.9%,31.3%vs.13.6%,P<0.05,respectively).Binary logistic regression analysis found that PaO_(2)<67.1 mmHg(OR=5.458,95%CI 1.730-17.220)on the first blood gas analysis and shock within 3 d(OR=26.585,95%CI 3.854-183.396)were independent risk factors for initial nHFOV failure(P<0.05).Conclusions The failure of initial nHFOV is correlated with the first blood gas parameters,EOS,hsPDA and shock within 3 d.Shock within 3 d and low PaO_(2)(<67.1 mmHg)were independent risk factors for initial nHFOV failure.