在早产婴儿少侵入性表面活性剂给药后,CPAP失败的预测因素
Miguel Alsina-Casanova1, Nerea Brito2, Carla Balcells-Esponera2
1Neonatology Department, Hospital Clínic Barcelona, BCNatal (Barcelona Center for Maternal-Fetal and Neonatal Medicine), Barcelona, Spain.
Frontiers in pediatrics
|September 11, 2024
概括
较少侵入性表面活性剂 (LISA) 的使用减少了早产婴儿的死亡和支气管肺功能障碍. 然而,在LISA后持续的正气道压力 (CPAP) 失败仍然是一个问题,特别是在极早产的婴儿中. 怀孕年龄和肺部超声波得分预测CPAP失败.
科学领域:
- 新生儿科学 新生儿科学
- 儿科呼吸系统医学 儿科呼吸系统医学
- 关键的护理关键的护理
背景情况:
- 较少侵入性表面活性剂 (LISA) 改善了早产婴儿患有呼吸困扰综合征的呼吸结果.
- 在LISA治疗后不久的机械通风 (MV) 与生存率下降有关.
- 了解LISA后的连续正气道压力 (CPAP) 失效对于优化护理至关重要.
研究的目的:
- 分析LISA后CPAP失败的趋势.
- 在早产婴儿的LISA后,确定CPAP失败的关键预测因素.
- 评估LISA和新生儿结局之间的关联,包括死亡和支气管肺功能失调 (BPD).
主要方法:
- 在2017-2022年期间在两个III级新生儿单位接受表面活性剂的早产婴儿 (23-33周妊娠年龄) 的回顾性队列研究.
- 收集的数据包括人口统计信息,肺超声波 (LUS) 评分,和/吸入氧气 (SF) 分数比,表面活性剂施用技术和新生儿结局.
- 统计分析包括调整的赔率比率 (aOR) 和后勤回归建模,以确定CPAP失败的预测因素.
主要成果:
- LISA在60.2%的婴儿中使用 (n=174) 并与减少死亡或BPD相关 (aOR=0.37).
- 在LISA后的CPAP失败发生在21.8%的婴儿中,与妊娠年龄 (GA) 反比例.
- CPAP失败的预测因素包括较低的GA,子宫内生长限制,较低的体温,较低的SF比率和较高的LUS分数 (Nagelkerke的R2=0.458).
结论:
- 在极度早产婴儿中,LISA后的CPAP衰竭很常见,增加死亡和残疾的风险.
- 妊娠年龄,子宫内生长限制,体温,SF比率和LUS分数是CPAP失败的重要预测因素.
- 这些发现强调需要仔细选择患者和技术选择,利用LUS和SF比率进行决策.
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