小儿重症肺炎经鼻高流量加温湿化氧疗撤机失败的危险因素分析

摘要
图/表
参考文献(20)
相关文章 (15)

全文: PDF (0 KB) HTML (47 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨小儿重症肺炎经鼻高流量加温湿化氧疗（HFNC）撤机失败的危险因素。方法回顾性分析2019年1月—2020年2月入住漳州市医院儿童重症监护室（PICU）的118 例小儿重症肺炎使用HFNC 者的临床资料，根据HFNC 是否成功撤离分为成功组（n=80）和失败组（n=38）。比较两组患儿的一般资料、动脉血气指标、基础病发生率、并发症发生率，采用多因素Logistic 回归分析小儿重症肺炎HFNC 撤机失败的危险因素。结果 118 例小儿重症肺炎使用HFNC 撤机失败的占比为32.20%。失败组患儿的总住院时间以及入住PICU 时间均长于成功组，差异有统计学意义（P＜0.05）；失败组患儿的白细胞、二氧化碳分压高于成功组，氧合指数低于成功组，差异有统计学意义（P＜0.05）；失败组存在心脏病、营养不良、早产儿等基础病的比例高于成功组，差异有统计学意义（P＜0.05）；失败组患儿并发心力衰竭、呼吸机相关肺炎的比例高于成功组，差异有统计学意义（P＜0.05）。多因素Logistic回归分析结果显示，合并心力衰竭（β=1.639，OR=5.148，95%CI：1.424～18.611）、早产儿（β=1.229，OR=3.418，95%CI：0.535～21.846）、总住院时间长（β=0.164, OR=1.178, 95%CI=1.039～1.336）是HFNC 失败的危险因素（P＜0.05），入院时氧合指数高（β=-0.015，OR=0.985，95%CI：0.975～0.996）是HFNC 撤机失败的保护因素（P＜0.05）。结论 HFNC 可以用于PICU 小儿重症肺炎的治疗，但是存在失败病例，存在基础病（如早产儿或合并有心力衰竭）是HFNC 撤机失败的高危因素，会增加总住院时间，入院时可通过相关病史及临床表现，结合血气及氧合指数，综合分析并进行初步判断，选择正确的呼吸支持模式，使患儿得到更好的治疗。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：儿童, 重症肺炎, 呼吸支持, 二氧化碳分压, 经鼻高流量加温湿化氧疗

Abstract：Objective To explore the risk factors for failure of high-flow nasal cannula oxygen therapy（HFNC）for severe pneumonia in children.Methods A total of 118 children with severe pneumonia treated with HFNC admitted to the Pediatric Intensive Care Unit (PICU) of Zhangzhou Hospital Affiliated to Fujian Medical University from January 2019 to February 2020 were retrospective analyzed.They were divided into success group (n=80) and failure group (n=38) according to whether HFNC was successfully withdrawn.The general data, arterial blood gas indexes, incidence of basic diseases and incidence of complications of the two groups were compared.Multivariate Logistic regression was used to analyze the risk factors of HFNC withdrawal failure in children with severe pneumonia.Results The failure rate of HFNC was 32.20% in 118 children with severe pneumonia.The total hospital stay and PICU stay in the failure group were longer than those in the successful group, the differences were statistically significant (P＜0.05).The white blood cell and partial pressure of carbon dioxide in the failed group were higher than those in the successful group, and the oxygenation index was lower than that in the successful group, the differences were statistically significant (P＜0.05).The proportions of heart disease, malnutrition, premature infant and other basic diseases in the failure group were higher than those in the success group, the differences were statistically significant (P＜0.05).The proportions of complicated heart failure and ventilator-associated pneumonia in the failure group were higher than those in the successful group,and the differences were statistically significant (P＜0.05).The results of multivariate Logistic regression analysis indicated that combined heart failure (β=1.639, OR=5.148, 95%CI=1.424-18.611), preterm infants (β=1.229, OR=3.418,95%CI=0.535-21.846) and long total hospital stay (β=0.164, OR=1.178, 95%CI=1.039-1.336) were risk factors for failure of HFNC (P＜0.05).High oxygenation index on admission (β=-0.015, OR=0.985, 95%CI=0.975-0.996) was the protective factors for HFNC failure (P＜0.05).Conclusion HFNC can be used for the treatment of severe pneumonia in children with pediatric intensive care unit, but cases of failure still exist.For children with underlying diseases such as premature infants or combined with heart failure, it is a high-risk factor for HFNC withdrawal failure, and will increase the total hospital stay.At admission, a preliminary judgment can be made by comprehensive analysis of related medical history and clinical manifestations, combined with blood gas and oxygenation index, and then select the appropriate respiratory support mode, so that the children can get better treatment.

Key words： Children Severe pneumonia Respiratory support Partial pressure of carbon dioxide High-flow nasal cannula oxygen therapy

收稿日期: 2020-08-04

引用本文:

郑丽玲；郑伟达；杨小云. 小儿重症肺炎经鼻高流量加温湿化氧疗撤机失败的危险因素分析[J]. 中国当代医药, 2021, 28(20): 21-25.
ZHENG Li-ling ZHENG Wei-da YANG Xiao-yun. Analysis of risk factors for failure of high-flow nasal cannula oxygen therapy for severe pneumonia in children. 中国当代医药, 2021, 28(20): 21-25.

链接本文:

http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I20/21

[1]	杨花珍.无创呼吸机治疗小儿重症肺炎的效果及安全性分析[J].中华灾害救援医学，2020，8（7）：370-372.
[2]	王卫平，孙锟，常立文.儿科学[M].9 版.北京：人民卫生出版社，2018：255.
[3]	Milesi.Relationship between pharyngeal pressure and gas flow during HFNC support[J].J Pediatr（Rio J），2017，93（Sl）：36-45.
[4]	唐艺菡，刘艳宾，邹敏，等.加温加湿经鼻导管高流量氧疗的研究[J].医学信息，2019，32（15）：48.
[5]	潘彩霞.经鼻高流量加温湿化氧疗的应用进展[J].医药前沿，2019，9（6）：7-8.
[6]	刘洁，李德渊，刘忠强，等.儿童经鼻高流量氧疗呼吸支持早期失败的高危因素分析[J].中国当代儿科杂志，2019，21（7）：650-655.
[7]	李长江.高流量湿化氧疗在呼吸系统感染性疾病治疗中的应用效果观察[J].临床合理用药，2018，12（8）：118-119.
[8]	Kwon JW.High-flow nasal cannula oxygen therapy in children：a clinical review[J].Clin Exp Pediatr，2020，63（1）：3-7.
[9]	Mosier JM，Sakles JC，Whitmore SP，et al.Failed noninvasive positive-pressure ventilation is associated with an increased risk of intubation-related complications[J].Ann Intensive Care，2015，5：4.
[10]	Taha DK，Kornhauser M，Greenspan JS，et al.High flow nasal cannula use is associated with increased morbidity and length of hospotalization in extremely low birth weight infants[J].JAMA Pediatr，2016，173：50-55.el.
[11]	Kamit F，Anil AB，Gokalp G，et al.Preemptive High Flow Nasal Cannula Treatment in Severe Bronchiolitis-Results from a High Volume Resource Limited Pediatric Emergency Department[J].Pediatr Int，2020，62（12）：1339-1345.
[12]	任锡凯，黄楠，苏苗赏.经鼻高流量氧疗与儿童呼吸支持治疗研究进展[J].温州医科大学学报，2020，50（7）：593-596.
[13]	Koga Y，Kaneda K，Fujii N，et al.Comparison of high-flow nasal cannula oxygen therapy and non-invasive ventilation as first-line therapy in respiratory failure：a multicenter retrospective study[J].Acute Med Surg，2020，7（1）：e461.
[14]	Spicuzza L，Schisano M.High-flow nasal cannula oxygen therapy as an emerging option for respiratory failure：the present and the future[J].Ther Adv Chronic Dis，2020，11：2040622320920106.
[15]	Ferguson ND，Fan E，Camporota L，et al.The Berlin definition of ARDS：an cxpanded rationale，justification，and supplementary material[J].Intensive Care Med，2012，38（10）：1573-1582.
[16]	惠智艳，袁伟伟，张旭，等.经鼻高流量氧疗在ICU 拔除气管导管后患者的序贯应用[J].临床急诊杂志，2020，21（2）：111-114.
[17]	Koyauchi T，Yasui H，Enomoto N，et al.Pulse oximetric saturation to fraction of inspired oxygen（SpO2/FiO2）ratio 24 hours after high-flow nasal cannula intiation is a good predictoe of HFNC therapy in patients with acute exacerbation of inteestitial lung disease[J].Ther Adv Respir Dis，2020，14：1753466620906327.
[18]	Artacho Ruiz R，Artacho Jurado B，Caballero Güeto F，et al.Predictors of success of high-flow nasal cannula in the treatment of acute hypoxemic respiratory failure[J].Med Intensiva，2019，24（19）：301 91-30 913.
[19]	Nishimura M.High-flow nasal cannula oxygen therapy in adults[J].J Intensive Care，2015，3（1）：15.
[20]	Kang BJ，Koh Y，Lim CM，et al.Failure of high-flow nasal cannula therapy may delay intubation and increase mortality[J].Intensive Care Med，2015，41（4）：623-632.