InSure技术治疗极早产儿呼吸窘迫综合征失败的高危因素分析

Risk factors for the failure of the InSure method in very preterm infants with respiratory distress syndrome

摘要:

目的 分析InSure 技术治疗极早产儿呼吸窘迫综合征（RDS）失败的高危因素。方法 回顾分析应用InSure 技术治疗的71 例RDS 极早产儿的临床资料，其中治疗成功组42 例，失败组29 例，比较两组患儿的一般情况，并行多因素logistic 回归分析。结果 InSure 技术失败率为41%。失败组在出生体重、产前糖皮质激素使用率、经阴道分娩率明显低于成功组（P<0.05），而动脉导管未闭发生率较成功组显著增加（P<0.05）；失败组的PaO₂、PaO₂/FiO₂、PaO₂/PAO₂ 均明显低于成功组（P<0.05），且PaCO₂ 较成功组明显增高（P<0.05）。Logistic 回归分析显示出生体重<1150 g（OR=22.240、95%CI=2.124~232.901）、PaCO₂>54 mm Hg（OR=9.360、95%CI=1.958~44.741）、及PaO₂/FiO₂<195（OR=6.570、95%CI=1.027~42.003）是InSure 技术治疗RDS 失败的独立危险因素。此外，失败组氧疗时间、住院时间及BPD 发生率均明显高于成功组（P<0.05）。结论 InSure技术治疗极早产儿RDS 失败的高危因素包括低出生体重、高PaCO₂ 及低PaO₂/FiO₂。

Abstract:

Objective To study the risk factors for the failure of the InSure method in very preterm infants with respiratory distress syndrome (RDS). Methods Seventy-one very preterm infants with RDS treated with InSure method were enrolled. These infants were categorized into two groups: InSure success (42 cases) and InSure failure (29 cases). The differences in basic information were compared between the two groups, and logistic regression analysis was used to identify the risk factors for InSure failure. Results The failure rate of the InSure method was 41%. The failure group were much lower in the birth weight, the antenatal steroids utilization rate and the vaginal delivery rate than the success group (P<0.05). The incidence of patent ductus arteriosus in the failure group was significantly higher than in the success group (P<0.05). PaO₂, PaO₂/FiO₂ and PaO₂/PAO₂ in the failure group were significantly lower than in the success group (P<0.05). PaCO₂ in the failure group was much higher than in the success group (P<0.05). Further logistic regression analysis showed that birth weight <1 150 g (OR=22.240 95%CI=2.124-232.901), PaCO₂>54 mm Hg(OR=9.360, 95%CI=1.958-44.741, and PaO₂/FiO₂ <195 (OR=6.570, 95%CI=1.027-42.003), were the independmend risk factors for InSure failure. Furthermore, the duration of oxygen therapy, the total time of hospitalization and the incidence of BPD in the failure group were much longer and higher than in the success group (P<0.05). Conclusions Low birth weight, elevated PaCO₂ and low PaO₂/PiO2 ratio are the risk factors for the failure of the InSure method in very preterm infants.