持续正压通气治疗婴儿毛细支气管炎失败的预测因素分析

Predictive factors for failure of continuous positive airway pressure treatment in infants with bronchiolitis

摘要:

目的 探讨持续正压通气（CPAP）治疗婴儿毛细支气管炎失败的预测因素。方法 回顾性分析310例1~12月龄使用CPAP治疗的毛细支气管炎住院患儿的临床资料，比较CPAP治疗成功组（270例）和失败组（40例）临床特征的差异，并采用多因素logistic回归分析探讨CPAP治疗失败的预测因素。结果 多因素logistic回归分析显示，第3代小儿死亡危险评分（PRISM Ⅲ）≥ 10分（OR=13.905）、并发肺不张（OR=12.080）、合并心功能不全（OR=7.741）及CPAP治疗2 h后氧合指数（动脉氧分压PaO₂/吸入氧浓度FiO₂，P/F）无显著改善（OR=34.084）是CPAP治疗毛细支气管炎失败的预测因素（P < 0.05）。CPAP治疗2 h后P/F无改善预测治疗失败的受试者工作特性曲线下面积为0.793，灵敏度和特异度分别为70.3%和82.4%（截断值为203）。结论 CPAP治疗2 h后P/F无显著改善、PRISM Ⅲ评分≥ 10分、并发肺不张、合并心功能不全可作为CPAP治疗婴儿毛细支气管炎失败的预测因素。

Abstract:

Objective To study the predictive factors for the failure of continuous positive airway pressure (CPAP) treatment in infants with bronchiolitis. Methods A retrospective analysis was performed on the clinical data of 310 hospitalized children (aged 1-12 months) with bronchiolitis treated with CPAP. Their clinical features were compared between the successful treatment group (270 cases) and the failed treatment group (40 cases). A multivariate logistic regression analysis was used to explore the predictive factors for failure of CPAP treatment. Results The multivariate logistic regression analysis showed that the score of the Pediatric Risk of Mortality III (PRISM III) ≥10 (OR=13.905), development of atelectasis (OR=12.080), comorbidity of cardiac insufficiency (OR=7.741), and no improvement in oxygenation index (arterial partial pressure of oxygen/fraction of inhaled oxygen, P/F) after 2 hours of CPAP treatment (OR=34.084) were predictive factors for failure of CPAP treatment for bronchiolitis (P < 0.05). In predicting CPAP treatment failure, no improvement in P/F after 2 hours of CPAP treatment had an area under the receiver operating characteristic curve of 0.793, with a sensitivity of 70.3% and a specificity of 82.4% at a cut-off value of 203. Conclusions No improvement in P/F after 2 hours of CPAP treatment, PRISM III score ≥10, development of atelectasis, and comorbidity of cardiac insufficiency can be used as predictive factors for CPAP treatment failure in infants with bronchiolitis.