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

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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were divided into success group (n=80) and failure group (n=38) according to whether HFNC was successfully withdrawn.The general data, arterial blood gas indexes, incidence of basic diseases and incidence of complications of the two groups were compared.Multivariate Logistic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

Received: 04 August 2020

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