不同胎龄早产儿早期CPAP失败的高危因素及临床结局

Risk Factors and Outcome of Early CPAP Failure in Preterm Infants at Different Gestational Ages

摘要: 目的：分析不同胎龄早产儿早期CPAP失败的高危因素及临床结局，优化呼吸支持策略，改善早产儿预后。方法：回顾性分析青岛大学附属医院2015年1月至2017年6月的303例早产儿初始采用CPAP治疗的临床资料。按照生后72小时内是否需要气管插管分为CPAP成功组和CPAP失败组。分析不同胎龄早产儿CPAP失败的高危因素及其临床结局。结果：胎龄25~27⁺⁶周、28~31⁺⁶周、32~36⁺⁶周早产儿CPAP失败率分别是38.9%、36.9%、26.3%。胸片分级是所有胎龄组早产儿CPAP失败的独立高危因素(胎龄25~27⁺⁶周、28~31⁺⁶周、32~36⁺⁶周的OR值及95% CI分别为4.196 (1.353~13.013)、25.769 (7.44~89.173)、69.009 (7.384~44.694))。此外妊娠期高血压、妊娠期糖尿病、胎膜早破是胎龄28~31⁺⁶周早产儿CPAP失败组的高危因素。胎龄 < 32周早产儿CPAP失败的气胸、支气管肺发育不良(bronchopulmonary dysplasia, BPD)、脑室内出血(intraventricular hemorrhage, IVH)发病率较成功组明显增加，呼吸支持时间明显延长。早产儿CPAP失败组的住院时间明显延长。结论：1) 胸片严重程度是各胎龄组早产儿CPAP失败的危险因素。2) 妊娠糖尿病、妊娠高血压、胎膜早破与早产儿CPAP失败有关。3) 胎龄小于32周早产儿CPAP失败的住院并发症明显增加。

Abstract: Objective: The risk factors and clinical outcomes of early CPAP failure were analyzed to improve the prognosis of premature infants. Methods: The clinical data of 303 premature infants initially treated with CPAP in the Affiliated Hospital of Qingdao University from January 2015 to June 2017 were retrospectively analyzed. According to the gestational age and whether intubated within 72 hours after birth, they were divided into CPAP-success group and CPAP-failure group. Risk factors and clinical outcomes of CPAP failure in preterm infants were analyzed. Results: The failure rates of CPAP at 25~27⁺⁶, 28~31⁺⁶, and 32~36⁺⁶ weeks gestation were 38.9%, 36.9%, and 26.3%, respectively. Radiological severity of RDS was an independent risk factor for CPAP failure in preterm infants at all gestational age groups. In addition, gestational hypertension, gestational diabetes mellitus and premature rupture of membranes were the risk factors for CPAP failure in preterm infants at 28~31⁺⁶ weeks gestation. Incidence of bronchial pulmonary dysplasia (bronchopulmonary dysplasia, BPD), pneumothorax, intraventricular hemorrhage (intraventricular hemorrhage, the IVH) increased significantly in CPAP-failure infants than CPAP-success group at <32 weeks gestation, along with significantly prolonged respiratory support duration. Hospitalization for CPAP failure in preterm infants was significantly prolonged. Conclusion: 1) Radiological severity of RDS was an independent risk factor for CPAP failure of premature infants in all gestational age groups. 2) Perinatal factors such as gestational diabetes, gestational hypertension and premature rupture of membranes were associated with CPAP failure in premature infants. 3) Hospitalization complications in CPAP failure infants less than 32 weeks gestation significantly increased.