全身性糖皮质激素预防儿童气管拔管后上气道梗阻的疗效分析  

Efficacy of systemic glucocorticoids on preventing postextubation upper airway obstruction in children

作　　者：谭娜 李科纯 钱素云[1] Tan Na;Li Kechun;Qian Suyun(Department of Pediatric Intensive Care Unit,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院重症医学科,北京100045

出　　处：《中华医学杂志》2025年第15期1184-1190,共7页National Medical Journal of China

基　　金：首都临床诊疗技术研究及转化应用(Z211100002921063)。

摘　　要：目的探讨全身性糖皮质激素(GC)预防儿童气管拔管后上气道梗阻(UAO)的疗效。方法回顾性收集2021年1月1日至12月31日首都医科大学附属北京儿童医院儿童重症监护病房(PICU)气管插管持续时间≥48 h患儿的临床资料。根据是否在拔管前24 h内使用全身性GC,分为GC使用组和GC未使用组。比较2组拔管后UAO发生率及拔管失败率,统计GC相关不良反应发生率。并分析拔管前24 h内使用全身性GC对拔管后UAO、拔管失败的影响;采用多因素logistic回归模型分析拔管后UAO、拔管失败的影响因素。为了进一步评估拔管前24 h内使用全身性GC对拔管后UAO的影响,将可能影响全身性GC疗效的患儿基本情况(性别、年龄、插管原因及插管持续时间)进行亚组分析。结果共纳入206例患儿,GC使用组共109例,男65例,女44例,年龄[M(Q1,Q3)]为32(12,87)个月;GC未使用组共97例,男70例,女27例,年龄为26(7,86)个月。GC使用组拔管后UAO发生率[17.4%(19/109)比36.1%(35/97),P=0.002]、拔管失败率[2.8%(3/109)比11.3%(11/97),P=0.015]均低于GC未使用组。最常见的全身性GC相关不良反应为新发感染(15.6%,17/109),其次为上消化道出血(6.4%,7/109)、高血糖(5.5%,6/109)、高血压(2.8%,3/109)。多因素logistic回归模型分析显示,拔管前24 h内使用全身性GC与拔管后UAO(OR=0.386,95%CI:0.198~0.753)及拔管失败(OR=0.234,95%CI:0.063~0.871)呈负向关联。亚组分析显示,拔管前24 h内使用全身性GC降低拔管后UAO发生率的疗效不受性别、年龄、插管原因及插管持续时间的影响(均P_(交互)>0.05)。结论全身性GC可能对预防儿童气管拔管后UAO有效。Objective To evaluate the efficacy of systemic glucocorticoid(GC)on preventing postextubation upper airway obstruction(UAO)in children.Methods Clinical data were retrospectively collected from the children with an intubation duration of≥48 hours in the Department of Pediatric Intensive Care Unit(PICU)of Beijing Children′s Hospital,Capital Medical University,from January 1,2021 to December 31,2021.The patients were divided into the GC-using group and the non-GC-using group according to whether systemic GC was used within 24 hours before extubation.The incidence of postextubation UAO and extubation failure were compared between the two groups.GC-related adverse effects were recorded.Additionally,the effects of systemic GC administration within 24 hours before extubation on postextubation UAO and extubation failure were evaluated.Multivariable logistic regression analysis was performed to determine the infiuencing factors for postextubation UAO and extubation failure.To further assess the impact of systemic GC administration within 24 hours before extubation on postextubation UAO,subgroup analyses were conducted based on patient characteristics that could influence GC efficacy,including sex,age,intubation reason,and intubation duration.Results A total of 206 children were enrolled.There were 109 cases in the GC-using group,including 65 males and 44 females,age[M(Q1,Q3)]was 32(12,87)months.There were 97 in the non-GC-using group,including 70 males and 27 females,aged 26(7,86)months.The incidence of postextubation UAO[17.4%(19/109)vs 36.1%(35/97),P=0.002]and extubation failure[2.8%(3/109)vs 11.3%(11/97),P=0.015]was lower in the GC-using group compared with the non-GC-using group.The most common GC-related adverse effect was new-onset infections(15.6%,17/109),followed by upper gastrointestinal bleeding(6.4%,7/109),hyperglycemia(5.5%,6/109),and hypertension(2.8%,3/109).Multivariable logistic regression analysis showed that systemic GC use within 24 hours before extubation was negatively associated with postextubatio

关 键 词：气道阻塞 糖皮质激素 气管拔管 疗效 儿童 

分 类 号：R725.6[医药卫生—儿科]