气管插管-肺表面活性物质-拔管策略治疗重度早产儿呼吸窘迫综合征无效的影响因素分析

Analysis of influencing factors of inefficacy of tracheal intubation-pulmonary surfactant-extubation strategy in the treatment of premature infants with severe respiratory distress syndrome

目的分析气管插管-肺表面活性物质-拔管(INSURE)策略治疗重度早产儿呼吸窘迫综合征(RDS)无效的影响因素。方法回顾性分析2013年11月至2020年10月本院于新生儿重症监护室行INSURE策略治疗的88例胎龄<34周重度早产儿RDS患儿的临床资料,采用单因素分析及多因素Logistic回归分析INSURE策略治疗重度早产儿RDS无效的危险因素,比较治疗有效与治疗无效患儿并发症发生率及住院时间。结果治疗期间共收治胎龄<34周早产儿821例,其中重度RDS117例,应用INSURE策略治疗患儿88例,治疗有效30例,治疗有效率为34.1%;治疗无效58例,无效率为65.9%。治疗无效患儿乳酸水平、呼吸评分及降钙素原(PCT)水平均高于治疗有效患儿,出生后因窒息需气囊复苏时间长于治疗有效患儿,出生后1 min Apgar评分低于治疗有效患儿,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,呼吸评分≥8分是INSURE策略治疗重度早产儿RDS无效的高危因素(OR=11.063,95%CI:1.127~28.576,P<0.05)。治疗无效患儿宫外发育迟缓发生率明显高于治疗有效患儿,差异有统计学意义(P<0.05);治疗有效与治疗无效患儿支气管肺发育不良(BPD)、脑室内出血(IVH)≥Ⅱ级、早产儿视网膜病(ROP)≥Ⅱ期、动脉导管未闭(PDA)发生率及住院时间比较差异无统计学意义。结论INSURE策略治疗早产儿重度RDS的无效率较高,呼吸评分≥8分是其治疗无效的危险因素,且治疗无效易导致患儿宫外发育迟缓,临床应根据危险因素制定预防措施。

Objective To analyze the influencing factors of inefficacy of tracheal intubation-pulmonary surfactant-extubation(INSURE)strategy in the treatment of premature infants with severe respiratory distress syndrome(RDS).Methods The clinical data of 88 cases of premature infants with severe RDS whose gestational age<34 weeks were treated with INSURE strategy in neonatal intensive care unit of our hospital from November 2013 to October 2020 were retrospectively analyzed.Univariate analysis and multivariate Logistic regression analysis were used to analyze the risk factors of inefficacy of INSURE strategy in the treatment of severe premature infants with severe RDS,and the incidence of complications and hospitalization time were compared between the children with effective and ineffective treatment.Results During the treatment,a total of 821 premature infants with gestational age<34 weeks were treated,including 117cases of severe RDS,of which 88 cases were treated with INSURE strategy,30 cases were treated effectively,and the effective rate was 34.1%o;and 58 cases were ineffective,the ineffective rate was 65.9%.The lactic acidlevel,respiratory score and procalcitonin(PCT)level in children with ineffective treatmentwere higher than those inchildren with effectivetreatment,the time of airbag resuscitation after birth due to asphyxation was longer than that in children with effectivetreatment,and the postnatal 1minApgar score was lower than that in children with effectivetreatment,and the differences were statistically significant(P<0.05).The results of multivariate Logistic regression analysis showed that respiratory score≥8 scoreswas high risk factor for inefficacy of INSURE strategy in the treatment of severe premature infants with severe RDS(OR=11.063,95%CI:1.127~28.576,P<0.05).The incidence of extrauterine growth retardation in children with ineffective treatment was significantly higher than that in children with effective treatment(P<0.05).There was no significant difference in the incidence of bronchopulmonary dysplasia(BPD),intraventricular hemorrhage(IVH)≥Ⅱ,retinopathy of prematurity(ROP)≥Ⅱ,patent ductus arteriosus(PDA)and hospitalization time between the children with effective and ineffective treatment(P>0.05).Conclusion INSURE strategy has high inefficiencyin the treatment of premature infants with severe RDS,respiratory score≥8 scoresis risk factor for ineffective treatment,and ineffective treatment is likely to lead to extrauterine growth,clinical preventive measures should be taken according to risk factors,to improve patients outcomes.