影响左向右分流型先心病新生儿撤机成功的多因素分析

目的研究不同因素对左向右分流型先心病新生儿呼吸机撤离(简称撤机)成功率的影响。方法收集左向右分流型先心病机械通气新生儿95例,定义48 h内无需重新插管者属撤机成功。以撤机成功率为因变量,以新生儿胎龄、体重、肺动脉压力水平、肺血流量、缺损大小、缺损类型、合并心衰、肺炎为自变量进行多元线性逐步回归,筛选出可能的影响因素,进一步研究不同影响因素对撤机成功率的影响。结果肺动脉压力、肺血流量大小和缺损类型是影响撤机成功率的重要因素(P均<0．05)。中重度肺动脉高压组的撤机成功率低于轻度肺动脉高压组(P均<0．05),差异有统计学意义。高肺血流量组的撤机成功率低于无高肺血流量组(P均<0．05),差异有统计学意义。联合缺损组的撤机成功率低于单纯缺损组(P均<0．05),差异有统计学意义。结论肺动脉压、肺血流量、缺损类型是影响撤机成功率的重要因素。

Influencing factors on ventilator weaning in neonates with left to right shunting congential heart disease

Objective To study the influencing factors related to ventilator weaning in neonates with left to right shunting congenital heart disease (CHD).Methods Clinical data of 95 ventilated neonates who had CHD were analyzed. Weaning successfully was defined as no re-intubation within 48 hours after ventilator weaning. Factors analyzed by linear regression included gestational age (GA) , gender, birth weight, pulmonary arterial pressure, pulmonary blood flow, diameter of the defect,type of the defect, complicating congestive heart failure and complicating pneumonia. Results Pulmonary arterial pressure, pulmonary blood flow and type of the defect were important factors influencing weaning results (P<0.05). Successfully weaning ratio in patients with moderate to severe pulmonary hypertension were significantly lower than those with mild pulmonary hypertension (P<0.05). High pulmonary blood flow had adverse effect on success weaning (P<0.05). Neonates with multiple defects had lower successful rate of weaning than those with simple defect (P<0.05).Conclusion Pulmonary arterial pressure,pulmonary blood flow and type of the defect are important influencing factors on ventilator weaning in neonates with left to right shunting CHD.