对早产儿动脉导管未闭根治术后呼吸失代偿进行表型分析。
Phenotyping respiratory decompensation following definitive closure of the patent ductus arteriosus in preterm infants.
机构信息
Department of Respiratory Care, Boston Children's Hospital, Boston, MA, USA.
Departments of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
J Perinatol. 2022 May;42(5):649-654. doi: 10.1038/s41372-021-01226-z. Epub 2021 Oct 14.
OBJECTIVE
To identify risk factors associated with high-frequency ventilation (HFV) following definitive closure of the patent ductus arteriosus (PDA).
METHODS
We performed a retrospective study of premature infants (<37 weeks) who were mechanically ventilated before and after surgical or transcatheter PDA closure. Primary outcome was HFV requirement within 24 h of procedure. Logistic regression was used to estimate clinical associations with post procedure HFV requirement.
RESULTS
We identified 110 infants who were mechanically ventilated before PDA closure, of which 48 (44%) escalated to HFV within 24 h after closure. In the multivariable model, surgical ligation (OR 21.5, 95% CI 1.6-284), elevated Respiratory Severity Score (RSS) 1 h post-procedure (OR 1.78, 95% CI 1.07-2.99) and 12 h post-procedure (OR 2.12, 95% CI 1.37-3.26) were independent predictors of HFV.
CONCLUSION
Surgical ligation and elevated RSS values over the first 12 h after PDA closure are risk factors for HFV.
目的
确定与动脉导管未闭（PDA）根治性闭合后高频通气（HFV）相关的危险因素。
方法
我们对接受机械通气的早产儿（<37 周）进行了一项回顾性研究，这些早产儿在接受 PDA 经导管或手术闭合前和闭合后都接受了机械通气。主要结局是在手术后 24 小时内需要高频通气。使用逻辑回归来估计与术后 HFV 需求相关的临床关联。
结果
我们确定了 110 名在 PDA 闭合前接受机械通气的婴儿，其中 48 名（44%）在闭合后 24 小时内需要高频通气。在多变量模型中，手术结扎（OR 21.5，95%CI 1.6-284）、术后 1 小时呼吸严重程度评分（RSS）升高（OR 1.78，95%CI 1.07-2.99）和术后 12 小时 RSS 升高（OR 2.12，95%CI 1.37-3.26）是 HFV 的独立预测因素。
结论
PDA 闭合后 12 小时内手术结扎和 RSS 值升高是 HFV 的危险因素。
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