Pierre Robin序列征患儿下颌骨牵张成骨术后首次撤机失败的危险因素:一项巢式病例对照研究  

Risk factors for first weaning failure following mandibular distraction osteogenesis in pediatric patients with Pierre Robin sequence: a nested case-control study

作　　者：王慧 王义霞 倪欢欢 王建设[1] 赵龙德[1] Wang Hui;Wang Yixia;Ni Huanhuan;Wang Jianshe;Zhao Longde(Department of Anesthesiology,Children's Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院麻醉科,南京210008

出　　处：《中华麻醉学杂志》2023年第5期555-558,共4页Chinese Journal of Anesthesiology

摘　　要：目的:筛选Pierre Robin序列征(PRS)患儿下颌骨牵张成骨术后首次撤机失败的危险因素。方法:收集2018年1月至2023年2月接受下颌骨牵张成骨术PRS患儿的临床资料,包括性别、年龄、是否早产、出生体质量、手术时体质量、是否合并腭裂、是否为综合征型PRS、是否合并喉软化/气管支气管软化、是否合并单纯先天性心脏病、是否合并复杂性先天性心脏病、是否行术前机械通气、是否存在术前肺部感染、血白蛋白浓度、可视喉镜下气管插管是否困难、手术时长、是否发生术后呼吸机相关性肺炎、首次撤机时机械通气时长、首次撤机时牵引长度等情况。将术后首次撤机失败的患儿纳入观察组,按1∶4的比例匹配对照病例纳入对照组。将组间比较差异有统计学意义的因素进行logistic回归分析,筛选术后首次撤机失败的危险因素。结果:与对照组比较,观察组患儿出生体质量、首次撤机时机械通气时长、首次撤机时牵引长度以及合并腭裂比率、术前肺部感染比率、术前机械通气比率、术后呼吸机相关性肺炎比率差异有统计学意义(P<0.05)。二元logistic逐步回归分析结果显示,术前机械通气(OR=18.154,95%CI 3.971~82.990,P<0.001)和术后呼吸机相关性肺炎(OR=36.942,95%CI 1.307~1043.985,P=0.034)是下颌骨牵张成骨术后首次撤机失败的独立危险因素,出生体质量增加(OR=0.225,95%CI 0.076~0.668,P=0.007)是其保护因素(P<0.05)。结论:术前机械通气和术后呼吸机相关性肺炎是PRS患儿下颌骨牵张成骨术后首次撤机失败的独立危险因素,出生体质量增加是其保护因素。Objective To identify the risk factors for the first weaning failure following mandibular distraction osteogenesis in pediatric patients with Pierre Robin sequence(PRS).MethodsClinical data of pediatric patients with PRS who underwent mandibular distraction osteogenesis from January 2018 to February 2023 were collected,including sex,age,premature birth,birth weight,surgical weight,cleft palate,syndrome type PRS,laryngeal/tracheobronchial malacia,simple congenital heart disease,complex congenital heart disease,preoperative mechanical ventilation,preoperative pulmonary infection,blood albumin concentration,difficulty in tracheal intubation under a visual laryngoscope,surgical duration,postoperative ventilator-associated pneumonia,duration of mechanical ventilation at first weaning,and traction length at first weaning.Children in whom the first postoperative machine withdrawal failed were included in observation group and matched to control cases(control group)in a 1∶4 ratio.The risk factors of whichP values were less than 0.05 would enter the logistic regression analysis to stratify the risk factors for postoperative weaning failure.ResultsThere were significant differences in birth weight,cleft palate,duration of mechanical ventilation and traction length at first weaning,rate of combined cleft palate,preoperative pulmonary infection rate,rate of preoperative mechanical ventilation,and rate of postoperative ventilator-associated pneumonia between the two groups(P<0.05).Binary logistic stepwise regression analysis showed that the preoperative mechanical ventilation(OR=18.154,95%CI 3.971-82.990,P<0.001)and postoperative ventilator-associated pneumonia(OR=36.942,95%CI 1.307-1043.985,P=0.034)were independent risk factors for first weaning failure after mandibular distraction osteogenesis,while birth weight gain(OR=0.225,95%CI 0.076-0.668,P=0.007)was a protective factor for first weaning failure(P<0.05).ConclusionsPreoperative mechanical ventilation and postoperative ventilator-associated pneumonia are independent ri

关 键 词：PIERRE ROBIN综合征 儿童 通气机 机械 危险因素 病例对照研究 下颌骨牵张成骨术 

分 类 号：R782.054[医药卫生—口腔医学]