Liu Hui-Qiang, Tong Xiao-Mei, Han Tong-Yan, Zhang Hui, Guo Ming, Zhang Xue-Feng, Liu Xin-Jian, Zhang Xiang, Zhang Ming-Tao, Liu Fang, Bao Li-Sha, Zheng Jun, Tian Xiu-Ying, Gao Qi, Zhang Wan-Xian, Duan Yang, Sun Fu-Qiang, Guo Wei, Li Ling, Xiao Min, Liu Wei-Li, Jiang Rui
Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2020 Mar;22(3):231-237. doi: 10.7499/j.issn.1008-8830.2020.03.010.
To identify risk factors for minimally invasive surfactant administration (MISA) failure in the treatment of preterm infants with respiratory distress syndrome (RDS) and the influence of MISA failure on neonatal outcome.
A retrospective analysis was performed for the clinical data of 148 preterm infants with a gestational age of ≤32 weeks and a clinical diagnosis of RDS, who were admitted to the neonatal intensive care unit of eight tertiary hospitals in Beijing, Tianjin and Hebei Province from July 1, 2017 to December 31, 2018 and were treated with MISA (bovine pulmonary surfactant, PS). According to whether MISA failure (defined as the need for mechanical ventilation within 72 hours after MISA) was observed, the infants were divided into two groups: MISA failure group (n=16) and MISA success (n=132). A logistic regression analysis was used to investigate the risk factors for MISA failure and its influence on neonatal outcome.
The MISA failure rate was 10.8% (16/148). The logistic regression analysis showed that a high incidence rate of grade >II RDS before PS administration, low mean arterial pressure and high pulse pressure before administration, a low dose of initial PS administration, and long injection time and operation time were the risk factors for MISA failure (OR=5.983, 1.210, 1.183, 1.055, 1.036, and 1.058 respectively, P<0.05). After the control for the above risk factors, the logistic regression analysis showed that the MISA failure group had a significantly higher incidence rate of bronchopulmonary dysplasia (BPD) (OR=8.537, P<0.05).
A high grade of RDS, a low mean arterial pressure, and a high pulse pressure before administration are independent risk factors for MISA failure, and a low dose of initial PS administration, a long injection time, and a long operation time may increase the risk of MISA failure. MISA failure may increase the incidence rate of BPD in preterm infants.
确定在治疗早产呼吸窘迫综合征（RDS）患儿时微创表面活性剂给药（MISA）失败的危险因素以及MISA失败对新生儿结局的影响。
对2017年7月1日至2018年12月31日在北京、天津和河北省8家三级医院新生儿重症监护病房收治的148例胎龄≤32周且临床诊断为RDS的早产患儿的临床资料进行回顾性分析，这些患儿接受了MISA（牛肺表面活性剂，PS）治疗。根据是否观察到MISA失败（定义为MISA后72小时内需要机械通气），将患儿分为两组：MISA失败组（n = 16）和MISA成功组（n = 132）。采用logistic回归分析研究MISA失败的危险因素及其对新生儿结局的影响。
MISA失败率为10.8%（16/148）。logistic回归分析显示，PS给药前>II级RDS的高发病率、给药前低平均动脉压和高脉压、初始PS给药低剂量以及长注射时间和手术时间是MISA失败的危险因素（OR分别为5.983、1.210、1.183、1.055、1.036和1.058，P<0.05）。在控制上述危险因素后，logistic回归分析显示MISA失败组支气管肺发育不良（BPD）的发病率显著更高（OR = 8.537，P<0.05）。
RDS程度高、给药前平均动脉压低和脉压高是MISA失败的独立危险因素，初始PS给药低剂量、长注射时间和长手术时间可能增加MISA失败的风险。MISA失败可能增加早产患儿BPD的发病率。
