国际医药卫生导报2025，Vol.31Issue(9)：1499-1505,7.DOI:10.3760/cma.j.cn441417-20241120-09018
新生儿呼吸窘迫综合征机械通气撤机失败的预警模型构建
Construction of early warning model for mechanical ventilation weaning failure in neonatal respiratory distress syndrome
摘要
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 x2 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.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Key words
Neonates/Respiratory distress syndrome/Mechanical ventilation/Weaning failure/Risk model引用本文复制引用
邓巧妮,常亚娜,周晓玉,康华..新生儿呼吸窘迫综合征机械通气撤机失败的预警模型构建[J].国际医药卫生导报,2025,31(9):1499-1505,7.基金项目
国家自然科学基金(81270725) （81270725）
陕西省重点研发计划(2020SF-010) National Natural Science Foundation of China(81270725) （2020SF-010）
Key Research and Development Program of Shaanxi Province(2020SF-010) （2020SF-010）
