Abstract:

 Objective　To explore the influencing factors of mechanical ventilation weaning failure in neonatal respiratory distress syndrome and constructing a risk prediction model. Methods　A total of 185 children with respiratory distress syndrome admitted to Baoji High-Tech Hospital from December 2021 to July 2024, who underwent mechanical ventilation within 72 hours after birth, were selected as the study objects, including 79 boys and 106 girls. The children were randomly divided into a training set (148 cases) and a validation set (37 cases) in a ratio of 4∶1. The children were categorized into a weaning failure group (22 cases) and a weaning success group (126 cases) according to whether they required reintubation within 72 hours after the initial weaning, the success rate of weaning was 85.14% (126/148).In the weaning failure group, there were 8 boys and 14 girls, gestation aged (29.41±0.63) weeks. In the weaning success group, there were 51 boys and 75 girls, gestation aged (30.15±0.48) weeks. Clinical data of the patients was collected, including gestational age, gender, weight, birth weight, 5-minute Apgar score after birth, intubation in the delivery room, etc. Independent sample t test and χ² test were used for statistical analysis. Multivariate logistic regression analysis was used to analyze the influencing factors of ventilation weaning failure in neonatal respiratory distress syndrome. A Nomogram model was established, and C-index was used to evaluate the discrimination. The predictive efficacy of the model for the failure of weaning from mechanical ventilation in children with respiratory distress syndrome was analyzed by using the receiver operating characteristic curve (ROC). Results　The gestational age of the weaning failed group was lower than that of the weaning success group, the FiO₂ and PCO₂ before weaning were higher than that of the weaning success group, the proportion of using high-dose caffeine was lower than that of the weaning success group, and the proportions of patent ductus arteriosus and ventilator-associated pneumonia were higher than that of the weaning success group (all P<0.05). Logistic regression analysis revealed that gestational age (OR=0.223, 95%CI: 0.067-0.737), high-dose caffeine use (OR=0.249, 95%CI: 0.075-0.825), FiO₂ before weaning (OR=3.766, 95%CI: 1.135-12.487), PCO₂ before weaning (OR=3.473, 95%CI: 1.047-11.516), patent ductus arteriosus (OR=3.951, 95%CI: 1.192-13.101), and ventilator-associated pneumonia (OR=5.038, 95%CI: 1.519-16.705) were independent risk factors for weaning failure in children with respiratory distress syndrome (all P<0.05). The nomogram model demonstrated a sensitivity of 0.784 and specificity of 0.877 in predicting weaning failure in the training set, with an area under the curve (AUC) of 0.851. In the validation set, the model achieved a sensitivity of 0.759 and specificity of 0.867, with an AUC of 0.844. Conclusions　Gestational age, caffeine dosage, FiO₂ and PCO₂ before weaning, patent ductus arteriosus, and ventilator-associated pneumonia are significantly associated with weaning failure in children with respiratory distress syndrome. The nomogram model developed in this study provides a valuable tool for early assessment of weaning failure risk in this population.

Key words: Neonates,  , Respiratory distress syndrome,  , Mechanical ventilation,  , Weaning failure,  , Risk model

摘要：

目的　探讨新生儿呼吸窘迫综合征机械通气撤机失败的影响因素，构建风险预测模型。方法　选取2021年12月至2024年7月在宝鸡高新医院出生后72 h内行机械通气的185例呼吸窘迫综合征患儿作为研究对象，男79例，女106例。按照4∶1的比例，将患儿随机分为训练集（148例）和验证集（37例）。根据患儿初次撤机后72 h内是否再次行气管插管，分为撤机失败组（22例）和撤机成功组（126例），撤机成功率为85.14%（126/148）。撤机失败组男8例，女14例；胎龄（29.41±0.63）周。撤机成功组男51例，女75例；胎龄（30.15±0.48）周。收集患儿临床资料，包括：胎龄、性别、出生体重、出生后5 min Apgar评分、产房内插管等。采用独立样本t检验、χ2检验进行统计学分析；采用logistic回归分析呼吸窘迫综合征患儿撤机失败的影响因素；建立Nomogram列线图模型，以C-index指数评估区分度；采用受试者操作特征曲线（ROC）分析该模型对呼吸窘迫综合征患儿撤机失败的预测效能。结果　撤机失败组胎龄小于撤机成功组，撤机前吸入氧浓度（FiO2）及二氧化碳分压（PCO2）均高于撤机成功组，使用高剂量咖啡因占比低于撤机成功组，动脉导管未闭和呼吸机相关性肺炎占比均高于撤机成功组（均P<0.05）。logistic回归分析结果显示，胎龄（OR=0.223，95%CI：0.067～0.737）、使用高剂量咖啡因（OR=0.249，95%CI：0.075～0.825）、撤机前FiO2（OR=3.766，95%CI：1.135～12.487）和PCO2（OR=3.473，95%CI：1.047～11.516）、动脉导管未闭（OR=3.951，95%CI：1.192～13.101）、呼吸机相关性肺炎（OR=5.038，95%CI：1.519～16.705）均是呼吸窘迫综合征患儿撤机失败的独立危险因素（均P<0.05）。列线图模型预测训练集呼吸窘迫综合征患儿撤机失败的灵敏度为0.784，特异度为0.877，曲线下面积为0.851。列线图模型预测验证集呼吸窘迫综合征患儿撤机失败的灵敏度为0.759，特异度为0.867，曲线下面积为0.844。结论　胎龄、咖啡因使用剂量、撤机前FiO2和PCO2、动脉导管未闭、呼吸机相关性肺炎均与呼吸窘迫综合征患儿撤机失败有关。本研究构建的列线图模型有助于早期评估呼吸窘迫综合征患儿撤机失败风险。

关键词:  , 新生儿, 呼吸窘迫综合征, 机械通气, 撤机失败, 风险模型