皮埃尔·罗班序列征新生儿行下颌骨牵张成形术拔管后低氧血症的危险因素分析  

Independent risk factors related to hypoxemia after extubation in neonates with Pierre Robin sequence undergoing mandibu⁃lar distraction osteogenesis

作　　者：宋丽 温辉 刘玥 张益 姚兰 Song Li;Wen Hui;Liu Yue;Zhang Yi;Yao Lan(Department of Anesthesia Surgery,Peking University International Hospital,Beijing 102206,China;Department of Maxillofacial Surgery,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]北京大学国际医院麻醉手术部,北京102206 [2]北京大学国际医院颌面外科,北京102206

出　　处：《国际麻醉学与复苏杂志》2022年第12期1282-1285,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的讨论皮埃尔·罗班序列征(Pierre Robin sequence,PRS)患儿接受下颌骨牵张成形术(mandibular distraction osteogenesis,MDO)拔管后低氧血症的危险因素。方法回顾性分析2016年1月至2021年10月北京大学国际医院接受MDO的84例PRS新生儿的临床资料。根据拔管后是否出现低氧血症(SpO2<90%时行医学干预)分为低氧血症组(50例)和无低氧血症组(34例)。记录低氧血症组患儿的医学干预措施。采用Logistic回归分析建立回归模型,筛选与拔管后低氧血症相关的独立危险因素。结果50例(59.5%)患儿拔管后发生低氧血症。医学干预措施包括:改变患儿体位38例(45.2%),置入鼻咽通气道8例(9.5%),再次置入喉罩机械通气4例(4.8%)。多因素Logistic回归分析显示,低体重[比值比(odds ratio,OR)1.263,95%CI 1.024~2.361,P=0.002]和拔管时间短(OR 0.331,95%CI 0.247~0.764,P=0.043)是拔管后低氧血症的独立危险因素。结论低体重是接受MDO的PRS新生儿拔管后低氧血症的独立危险因素,拔管时间较短的患儿低氧血症发生率较高。Objective To investigate the risk factors associated with hypoxemia after extubation in neonates with Pierre Robin sequence(PRS)undergoing mandibular distraction osteogenesis(MDO).Methods A total of 84 PRS neonates who underwent MDO in Peking University International Hospital from January 2016 to October 2021 were enrolled and their clinical data were retrospectively analyzed.According to the presence of hypoxemia after extubation[medical intervention at pulse oxygen saturation(SpO2)<90%],they were divided into two groups:a hypoxemia group(n=50)and a non‑hypoxemia group(n=34).The medical interventions of the hypoxemia group were recorded.Logistic regression analysis was utilized to establish a predictive mode to identify the independent risk factors related to hypoxemia.Results There were 50 babies(59.5%)who developed hypoxemia after extubation.Medical interventions included changing posture in 38 neonates(45.2%),placing a nasopharyngeal airway in 8 children(9.5%)and placing a laryngeal mask for mechanical ventilation in 4 children(4.8%).Multivariate logistic regression showed the independent risk factors of hypoxemia were lower‑body weight[odds ratio(OR)1.263,[95%confidence interval(CI)1.024,2.361],P=0.002]and shorter extubation time[OR 0.331(95%CI 0.247,0.764),P=0.043].Conclusions Lower‑body weight is an independent risk factor for hypoxemia after extubation in PRS neonates undergoing MDO,and babies with shorter extubation time is a higher incidence of hypoxemia.

关 键 词：皮埃尔·罗班序列征 新生儿 下颌骨牵张成形术 低氧血症 

分 类 号：R726.1[医药卫生—儿科]