Luo Si-Ying, Wu Yi, Yi Qian, Wang Zhi-Li, Tang Yuan, Zhang Guang-Li, Tian Xiao-Yin, Luo Zheng-Xiu
Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2020 Apr;22(4):339-345. doi: 10.7499/j.issn.1008-8830.1910026.
To study the predictive factors for the failure of continuous positive airway pressure (CPAP) treatment in infants with bronchiolitis.
A retrospective analysis was performed on the clinical data of 310 hospitalized children (aged 1-12 months) with bronchiolitis treated with CPAP. Their clinical features were compared between the successful treatment group (270 cases) and the failed treatment group (40 cases). A multivariate logistic regression analysis was used to explore the predictive factors for failure of CPAP treatment.
The multivariate logistic regression analysis showed that the score of the Pediatric Risk of Mortality III (PRISM III) ≥10 (OR=13.905), development of atelectasis (OR=12.080), comorbidity of cardiac insufficiency (OR=7.741), and no improvement in oxygenation index (arterial partial pressure of oxygen/fraction of inhaled oxygen, P/F) after 2 hours of CPAP treatment (OR=34.084) were predictive factors for failure of CPAP treatment for bronchiolitis (P<0.05). In predicting CPAP treatment failure, no improvement in P/F after 2 hours of CPAP treatment had an area under the receiver operating characteristic curve of 0.793, with a sensitivity of 70.3% and a specificity of 82.4% at a cut-off value of 203.
No improvement in P/F after 2 hours of CPAP treatment, PRISM III score ≥10, development of atelectasis, and comorbidity of cardiac insufficiency can be used as predictive factors for CPAP treatment failure in infants with bronchiolitis.
研究毛细支气管炎患儿持续气道正压通气（CPAP）治疗失败的预测因素。
对310例接受CPAP治疗的住院毛细支气管炎患儿（年龄1 - 12个月）的临床资料进行回顾性分析。比较成功治疗组（270例）和治疗失败组（40例）的临床特征。采用多因素logistic回归分析探讨CPAP治疗失败的预测因素。
多因素logistic回归分析显示，小儿死亡风险评分Ⅲ（PRISMⅢ）≥10（OR = 13.905）、肺不张的发生（OR = 12.080）、合并心功能不全（OR = 7.741）以及CPAP治疗2小时后氧合指数（动脉血氧分压/吸入氧分数，P/F）无改善（OR = 34.084）是毛细支气管炎CPAP治疗失败的预测因素（P < 0.05）。在预测CPAP治疗失败方面，CPAP治疗2小时后P/F无改善在受试者工作特征曲线下面积为0.793，在截断值为203时，敏感度为70.3%，特异度为82.4%。
CPAP治疗2小时后P/F无改善、PRISMⅢ评分≥10、肺不张的发生以及合并心功能不全可作为毛细支气管炎患儿CPAP治疗失败的预测因素。
