机构地区:[1]北京大学第三医院儿科,北京100191 [2]中国人民解放军总医院第五医学中心新生儿科,北京100039 [3]中国石油天然气集团公司中心医院新生儿科,河北廊坊065000 [4]中国人民解放军联勤保障部队第980医院新生儿科,河北石家庄050082 [5]天津市中心妇产科医院新生儿科,天津300100 [6]天津医科大学第二医院新生儿科,天津300211 [7]河北省邢台市人民医院新生儿科,河北邢台054001 [8]沧州市中心医院新生儿科,河北沧州061001
出 处:《中国当代儿科杂志》2020年第3期231-237,共7页Chinese Journal of Contemporary Pediatrics
摘 要:目的探讨肺表面活性物质微创给药方式(MISA)治疗早产儿呼吸窘迫综合征(RDS)失败的高危因素及其对早产儿的影响.方法回顾性分析2017年7月1日至2018年12月31日京津冀地区8家三级医院新生儿重症监护病房应用MISA给予牛肺表面活性物质(PS)治疗胎龄≤32周,且临床考虑为RDS早产儿(n=148)的基本信息、围产期情况、用药情况、合并症、临床转归等病例资料.根据MISA治疗是否失败(MISA失败定义为MISA后72 h内需要机械通气)分为MISA失败组(n=16)和MISA成功组(n=132).应用logistic回归分析MISA失败的高危因素及其对早产儿的影响.结果MISA失败率为10.8%(16/148).logistic回归分析结果显示用药前RDS>Ⅱ级发生率高、用药前平均动脉压低、用药前脉压差大、首次给药剂量低、注药时间及总操作时间长是MISA失败的危险因素(分别OR=5.983、1.210、1.183、1.055、1.036、1.058,P<0.05).控制上述高危因素后行logistic回归分析结果显示MISA失败组BPD的发生率高(OR=8.537,P<0.05).结论给药前RDS程度重、血压监测平均动脉压低、脉压差大是MISA失败的独立危险因素;首次PS给药剂量低、注药时间及总操作时间长可能增加MISA失败的风险;MISA失败可能导致早产儿BPD发生率增加.Objective To identify risk factors for minimally invasive surfactant administration(MISA)failure in the treatment of preterm infants with respiratory distress syndrome(RDS)and the influence of MISA failure on neonatal outcome.Methods A retrospective analysis was performed for the clinical data of 148 preterm infants with a gestational age of≤32 weeks and a clinical diagnosis of RDS,who were admitted to the neonatal intensive care unit of eight tertiary hospitals in Beijing,Tianjin and Hebei Province from July 1,2017 to December 31,2018 and were treated with MISA(bovine pulmonary surfactant,PS).According to whether MISA failure(defined as the need for mechanical ventilation within 72 hours after MISA)was observed,the infants were divided into two groups:MISA failure group (n=16) and MISA success (n=132). A logistic regression analysis was used to investigate the risk factors forMISA failure and its influence on neonatal outcome. Results The MISA failure rate was 10.8% (16/148). The logisticregression analysis showed that a high incidence rate of grade >II RDS before PS administration, low mean arterialpressure and high pulse pressure before administration, a low dose of initial PS administration, and long injection timeand operation time were the risk factors for MISA failure (OR=5.983, 1.210, 1.183, 1.055, 1.036, and 1.058 respectively,P<0.05). After the control for the above risk factors, the logistic regression analysis showed that the MISA failure grouphad a significantly higher incidence rate of bronchopulmonary dysplasia (BPD) (OR=8.537, P<0.05). Conclusions Ahigh grade of RDS, a low mean arterial pressure, and a high pulse pressure before administration are independent riskfactors for MISA failure, and a low dose of initial PS administration, a long injection time, and a long operation timemay increase the risk of MISA failure. MISA failure may increase the incidence rate of BPD in preterm infants.
关 键 词:新生儿呼吸窘迫综合征 微创给药 肺表面活性物质 早产儿
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