肺透明膜病新生儿经鼻持续正压通气治疗中压力不稳定发生情况及危险因素分析  

Analysis of occurrence and risk factors of pressure instability in neonates with hyaline membrane disease during nasal continuous positive airway pressure ventilation

作　　者：钟艳玲 刘彦彦 ZHONG Yanling;LIU Yanyan(Department of Neonatology,Yichun Maternal and Child Health Care Hospital,Jiangxi Province,Yichun 336000,China)

机构地区：[1]江西省宜春市妇幼保健院新生儿科,江西宜春336000

出　　处：《中国当代医药》2023年第8期123-126,共4页China Modern Medicine

基　　金：江西省宜春市科技计划项目(2022ZDJH6055)。

摘　　要：目的探讨肺透明膜病(HMD)新生儿经鼻持续正压通气(NCPAP)压力不稳定发生情况及危险因素。方法回顾性选取宜春市妇幼保健院新生儿科2021年1月至2022年7月收治的86例HMD并接受NCPAP治疗患儿为研究对象,将NCPAP压力不稳定的HMD患儿纳入不稳定组(n=27),剩余患儿纳入稳定组(n=59)。查阅患儿临床资料,包括胎龄、分娩方式、新生儿阿氏(Apgar)评分等项目,采用单因素及多因素回归分析筛选压力不稳定发生的影响因素。结果本研究纳入的86例HMD患儿中,行NCPAP过程中压力异常报警次数≥3次者共计27例,占比31.40%。单因素分析结果显示,不稳定组的出生体重≤2.5 kg、NCPAP时间≥3 d、患儿躁动、鼻导管脱落、导管扭曲、管内冷凝水过多、鼻黏膜损伤及分泌物堵塞气道占比高于稳定组,差异有统计学意义(P<0.05);多因素logistis回归分析结果显示,NCPAP时间≥3 d(β=0.734,OR=2.083,95%CI=1.220~3.558)、患儿躁动(β=0.715,OR=2.044,95%CI=1.331~3.140)、鼻导管脱落(β=0.648,OR=1.912,95%CI=1.047~3.489)、导管扭曲(β=0.718,OR=2.050,95%CI=1.108~3.794)、管路冷凝水过多(β=0.636,OR=1.889,95%CI=1.115~3.200)、鼻黏膜损伤(β=0.765,OR=2.149,95%CI=1.377~3.353)及分泌物堵塞气道(β=0.634,OR=1.902,95%CI=1.198~3.021)是HMD患儿NCPAP过程中压力不稳定的独立危险因素(P<0.05)。结论胎龄32周以下的HMD患儿行NCPAP治疗时压力不稳定发生率较高,且NCPAP时间超过3 d、鼻导管脱落、患儿躁动、导管扭曲、管内冷凝水过多、鼻黏膜损伤及分泌物堵塞气道均是HMD患儿NCPAP过程中压力不稳定的危险因素,临床护理中需重点关注胎龄32周以下HMD患儿的NCPAP过程,并针对性排除压力不稳定危险因素。Objective To investigate the occurrence and risk factors of pressure instability in neonates with hyaline membrane disease(HMD)undergoing nasal continuous positive airway pressure ventilation(NCPAP).Methods A total of 86 children with HMD who received NCPAP treatment from January 2021 to July 2022 in the Neonatology Department of Yichun Maternal and Child Health Hospital were retrospectively selected as the study objects.The children with unstable NCPAP pressure were included in the unstable group(n=27),and the remaining children were included in the stable group(n=59).The clinical data of the children,including gestational age,mode of delivery and Apgar score of newborns were consulted,and the influencing factors of stress instability were screened by univariate and multivariate regression analysis.Results Among the 86 children with HMD included in this study,there were 27 cases of abnormal pressure alarm≥3 times during NCPAP,accounting for 31.40%.Univariate analysis showed that birth weight≤2.5 kg,NCPAP time≥3 d,agitation,nasal catheter loss,catheter distortion,excessive condensate in the tube,nasal mucosa injury and secretion blocking airway in the unstable group were higher than those in the stable group,and the differences were statistically significant(P<0.05).Multivariate logistis regression analysis showed that NCPAP duration≥3 d(β=0.734,OR=2.083,95%CI=1.220-3.558),restfulness(β=0.715,OR=2.044,95%CI=1.331-3.140),nasal catheter detachment(β=0.648,OR=1.912,95%CI=1.047-3.489),catheter distortion(β=0.718,OR=2.050,95%CI=1.108-3.794),excessive condensate water in the pipeline(β=0.636,OR=1.889,95%CI=1.115-3.200),nasal mucosa injury(β=0.765,OR=2.149,95%CI=1.377-3.353)and secretions obstructing the airway(β=0.634,OR=1.902,95%CI=1.198-3.021)were independent risk factors for stress instability during NCPAP in children with HMD(P<0.05).Conclusion HMD children with gestational age less than 32 weeks have a higher incidence of pressure instability during NCPAP treatment,and the NCPAP time exceeding 3 day

关 键 词：肺透明膜病 新生儿 正压通气治疗 危险因素 

分 类 号：R722.1[医药卫生—儿科]