BiPAP联合INSURE技术治疗新生儿呼吸窘迫综合征失败的影响因素分析

目的 探讨双水平气道正压通气(bilevel positive airwaypressure,BiPAP)联合气管插管—肺表面活性物质(pulmonany surfactant,PS)—拔管给予鼻塞式气道正压通气(continuaus postive airway pressure,CPAP)技术(intubate-surfactant-extubate to CPAP,INSURE)治疗新生儿呼吸窘迫综合征失败的影响因素。方法 回顾性分析2015年5月至2019年5月西安高新医院出生的78例呼吸窘迫综合新生儿的资料,统计BiPAP联合INSURE治疗失败率,对比2组治疗失败和成功患儿临床资料,采用Logistic回归分析影响因素。结果 BiPAP联合INSURE治疗新生儿呼吸窘迫综合征失败率为28.21%;两组肺出血、重度窒息、宫内窘迫、宫内感染构成比及动脉血二氧化碳分压(PaCO₂)、胎龄、出生体重比较,差异有统计学意义(P＜0.05);Logistic多因素分析显示,肺出血、重度窒息、宫内窘迫、胎龄＜30周、出生体重＜1.2 kg、宫内感染、PaCO₂＞55 mmHg均是影响BiPAP联合INSURE治疗新生儿呼吸窘迫综合征失败的独立危险因素(OR=2.438、2.081、2.328、2.008、2.030、2.059、2.340)。结论 肺出血、重度窒息、宫内窘迫、胎龄＜30周、出生体重＜1.2 kg、宫内感染、PaCO₂＞55 mmHg均是影响BiPAP联合INSURE治疗新生儿呼吸窘迫综合征失败的独立危险因素,应加强防范。

Analysis of the influencing factors of the failure of BiPAP combined with INSURE in the treatment of neonatal respiratory distress syndrome

Objective To explore bilevel positive airway pressure (BiPAP) combined with tracheal intubation-pulmonary surfactant (PS)-continuall postive airway pressupe(CPAP) technology(intubate-surfactant-extubate to CPAP,INSURE) to treat neonatal breathing factors influencing the failure of distress syndrome. Methods Retrospectively analyzed the data of 78 neonates with respiratory distress syndrome born in Xi'an High-tech Hospital from May 2015 to May 2019,and calculated the failure rate of BiPAP combined with INSURE,and compared the clinical data of the two groups with failed and successful treatment.Logistic regression was used to analyze the influencing factors. Results The failure rate of BiPAP combined with INSURE in the treatment of neonatal respiratory distress syndrome was 28.21%; Comparison of pulmonary hemorrhage,severe asphyxia,intrauterine distress,intrauterine infection,arterial partial pressure of carbon dioxide(PaCO₂),gestational age,and birth weight between the two groups was statistically significant (P＜0.05).Logistic multivariate analysis showed that pulmonary hemorrhage,severe asphyxia,intrauterine distress,gestational age ＜30 weeks,birth weight ＜1.2 kg,intrauterine infection,PaCO₂＞55 mmHg all influence the failure of BiPAP combined with INSURE in the treatment of neonatal respiratory distress syndrome Independent risk factors(OR=2.438,2.081,2.328,2.008,2.030,2.059,2.340). Conclusion Pulmonary hemorrhage,severe asphyxia,intrauterine distress,gestational age ＜30 weeks,birth weight ＜1.2 kg,intrauterine infection,PaCO₂＞55 mmHg are all independent risk factors that affect the failure of BiPAP combined with INSURE in the treatment of neonatal respiratory distress syndrome.