摘要
目的探讨急性呼吸功能不全患儿经鼻高流量氧疗(HFNC)早期失败的高危因素.方法回顾性分析2018年1~6月入住儿童重症监护室的123例行HFNC呼吸支持的急性呼吸功能不全患儿的临床资料.将住院期间无需升级呼吸支持方式,且成功撤离HFNC的患儿归为HFNC成功组(69例);其余患儿在住院期间需升级呼吸支持方式(54例),其中使用HFNC 48 h内升级呼吸支持方式的患儿归为HFNC早期失败组(46例).采用多因素logistic回归分析评估分析HFNC早期失败的危险因素.结果 HFNC早期失败组罹患休克、脓毒症、颅内高压综合征或多器官功能障碍综合征的比例显著高于HFNC成功组(P<0.05).早期失败组实施呼吸支持前的格拉斯哥昏迷评分、pH值、氧合指数均显著低于HFNC成功组(P<0.05),而小儿死亡风险评分(PRISM评分)、PaCO2/PaO2比值显著高于HFNC成功组(P<0.05).多因素logistic回归分析显示,PRISM评分>4.5分和PaCO2/PaO2比值>0.64是HFNC早期失败的独立危险因素(OR分别为5.535、9.089,P<0.05).结论 PRISM评分>4.5分或PaCO2/PaO2比值>0.64的急性呼吸功能不全患儿行HFNC早期失败的风险较高.
Objective To determine the high-risk factors for early failure of high-flow nasal cannula (HFNC) oxygen therapy in children with acute respiratory insufficiency (ARI). Methods The clinical data of 123 children with ARI were reviewed who received HFNC oxygen therapy in the pediatric intensive care unit from January to June, 201& The children who did not require an upgrade of respiratory support during hospitalization and were successfully weaned from HFNC were classified as HFNC success group (69 cases). Of the remaining children (54 cases) who required an upgrade of their respiratory support during hospitalization, those that needed to upgrade their respiratory support within 48 hours of receiving HFNC were classified as early HFNC failure group (46 cases). Risk factors for early failure of HFNC were determined using multivariate logistic regression analysis. Results The incidence rates of shock, sepsis, intracranial hypertension syndrome, and multiple organ dysfunction syndrome were significantly higher in the early HFNC failure group than in the HFNC success group (P<0.05). Before implementation of respiratory support, the early HFNC failure group had significantly lower Glasgow coma score, pH value, and oxygenation index and significantly higher Pediatric Risk of Mortality (PRISM) score and PaCO2/PaO2 ratio than the HFNC success group (P<0.05). Multivariate logistic regression analysis showed that PRISM score >4.5 and PaCO2/PaO2 ratio >0.64 were independent risk factors for early HFNC failure (OR=5.535 and 9.089 respectively;P<0.05). Conclusions Pediatric ARI patients with PRISM score >4.5 or PaCO2/PaO2 ratio >0.64 have relatively high risk of early HFNC failure.
作者
刘洁
李德渊
刘忠强
卢国艳
黎小庆
乔莉娜
LIU Jie;LI De-Yuan;LIU Zhong-Qiang;LU Guo-Yan;LI Xiao-Qing;QIAO Li-Na(Pediatric Intensive Care Unit,West China Second Hospital of Sichuan University,Chengdu 610041,China)
出处
《中国当代儿科杂志》
CAS
CSCD
北大核心
2019年第7期650-655,共6页
Chinese Journal of Contemporary Pediatrics
基金
四川省学术和技术带头人培养支持项目[川人社办发(2017)919-23]
四川省科技计划项目(2019YFS0245)
关键词
急性呼吸功能不全
经鼻高流量氧疗
危险因素
儿童
Acute respiratory insufficiency
High-flow nasal cannula oxygen therapy
Risk factor
Child
