新生儿全麻腹部手术后有创机械通气时长及其影响因素

Duration and risk factors of invasive mechanical ventilation after neonatal abdominal surgery under general anesthesia

目的:探讨新生儿重症监护病房(neonatal intensive care unit,NICU)患儿接受全麻腹部手术后有创机械通气时长及其影响因素。方法:本研究为单中心回顾性观察性研究。选择2018—2020年在北京儿童医院NICU住院、接受全麻下腹部手术且术后需有创机械通气的患儿为研究对象,根据术后机械通气时长分为<72 h组和≥72 h组,利用多因素logistic回归方法分析患儿术后机械通气时长的影响因素。结果:共纳入113例患儿,男婴57例(50.4%),出生胎龄(35.7±3.6)周,出生体重(2497±933)g,手术日龄9.9(3.6,22.2)d,住院时间为22.0(12.0,37.0)d。出院第一诊断前3位分别是先天性肠梗阻(37/113,32.7%)、坏死性小肠结肠炎(28/113,24.8%)和消化道穿孔(17/113,15.0%)。手术时长80.0(55.8,117.3)min,患儿术后全部需有创机械通气,时长30.0(7.0,84.5)h,其中48例(42.5%)术后24 h内拔除气管插管。多因素logistic回归分析显示,术前需呼吸支持(P=0.004)、合并先天性心脏病(P=0.013)、静脉输注咪达唑仑(P=0.032)是患儿术后有创机械通气时间延长的独立危险因素。结论:术前需呼吸支持、合并先天性心脏病、静脉输注咪达唑仑是全麻腹部手术患儿术后有创机械通气时间延长的独立危险因素。

Objective To study the duration of invasive mechanical ventilation(MV)and its influencing factors after neonatal abdominal surgery under general anesthesia in neonatal intensive care unit(NICU).Methods From January 2018 to December 2020,neonates received abdominal surgery under general anesthesia and needed endotracheal intubation and MV after surgery in NICU of our hospital were retrospectively studied.According to MV duration,the neonates were assigned into<72 h group and≥72 h group.Multivariate logistic regression was used to analyze the risk factors of postoperative MV duration.Results A total of 113 neonates were enrolled,including 57 male(50.4%)and 56 female(49.6%).The gestational age was(35.7±3.6)weeks,the birth weight was(2497±933)g,the average operation age was 9.9(3.6,22.2)d and the average hospital stay was 22.0(12.0,37.0)d.Congenital intestinal obstruction(37/113,32.7%)was the most common diagnoses on discharge,followed by neonatal necrotizing enterocolitis(28/113,24.8%)and gastrointestinal perforation(18/113,15.0%).The duration of operation was 80.0(55.8,117.3)min.All neonates needed MV with endotracheal intubation.The duration of postoperative respiratory support was 30.0(7.0,84.5)h.48 neonates(42.5%)had endotracheal intubation removed within 24 h after surgery.Multivariate logistic regression analysis showed that preoperative respiratory support(P=0.004),congenital heart disease(P=0.013)and intravenous midazolam(P=0.032)were independent risk factors for prolonged postoperative MV.Conclusions The need of preoperative respiratory support,congential heart disease and intravenous midazolam were independent risk factors for the duration of postoperative MV after neonatal abdominal surgery under general anesthesia.