新生儿机械通气撤机失败的影响因素及预测指标分析

目的探讨导致新生儿机械通气撤机失败的影响因素及寻找预测指标减少撤机失败率。方法回顾性分析我院2015年1月至2019年12月新生儿重症监护病室350例机械通气时间≥72 h并存活的新生儿。根据撤机48 h内是否再次插管,分为撤机成功组与撤机失败组。比较两组撤机前一般情况、临床变量、呼吸机设置及血气分析,撤机后无创通气模式及雾化情况。单因素及多因素分析确定高危因素,并预测指标价值。结果47例(13.4%)发生撤机失败。单因素分析显示15个变量是撤机失败的影响因素(P<0.05)。Logistic回归分析示机械通气时间长、吸痰耐受能力差、多脏器损害、高PCO 2、撤机时自主呼吸及心率快是撤机失败的高危因素(P<0.05)。PCO₂预测撤机失败价值高,AUC为0.819(0.738,0.900),P<0.001。结论多种因素与撤机失败相关,应针对高危因素进行干预,撤机前进行充分预测评估以减少撤机失败率。

Analysis of influencing factors and predictors of weaning failure in newborn infants subjected to mechanical ventilation

Objective To study the influencing factors of weaning failure in newborn infants subjected to mechanical ventilation and find the predictors to reduce the failure rate.Methods Retrospective analysis was performed on 350 newborn infants with mechanical ventilation duration≥72 h in neonatal intensive care unit of our hospital from January 2015 to December 2019.According to whether intubation was repeated within 48 hours after weaning,they were divided into the successful group and the failure group.Comparison of general conditions,clinical variables,ventilator settings and blood gas analysis before and after weaning,noninvasive ventilation modes and nebulization after weaning were compared between the two groups.Univariate and multivariate analysis were used to determine risk factors and predict the value of the indicator.Results Weaning failure occurred in 47 cases(13.4%).Univariate analysis showed that 15 variables were related to weaning failure(P<0.05).Logistic regression analysis showed that long mechanical ventilation time,poor sputum aspiration tolerance,multiple organs damage,high PCO 2,fast spontaneous breathing and rapid heart rate were the high risk factors for weaning failure(P<0.05).PCO₂ had high predictive value for weaning failure,and its AUC was 0.819(0.739~0.899)(P<0.001).Conclusion A variety of factors are related to weaning failure.Clinical interventions should be carried out for these risk factors,and full predictive evaluations should be conducted before weaning,so as to reduce the weaning failure rate.