背景:本研究旨在分析新生儿首次拔管时使用皮质类固醇和肾上腺素的情况,并比较拔管成功和失败的婴儿的临床特征。
方法:这是一项回顾性队列研究,在台湾一个单一的III级新生儿重症监护病房进行。该研究包括215名在2020年至2021年之间出生的婴儿,他们在首次尝试拔管之前已经插管超过48小时。我们比较了两组围产期和围拔管期的特点和结局。成功拔管定义为拔管后72小时无侵入性通气支持。皮质类固醇之间的关系,局部肾上腺素,采用多因素logistic回归分析确定拔管成功.
结果:在单变量分析中,拔管失败组接受静脉注射地塞米松的比例显著高于拔管成功组(p=0.006).此外,与成功拔管组相比,拔管失败组的肾上腺素雾化吸入持续时间更长(p=0.034),并且喉上段局部应用肾上腺素的次数更多(p=0.003).多因素分析显示,没有肺不张,拔管后72h心动过速,拔管后较低的PCO2是成功拔管的关键因素。
结论:有全身性地塞米松的趋势,局部应用肾上腺素上喉,再插管组雾化吸入肾上腺素的持续时间更长。然而,使用皮质类固醇或局部肾上腺素与成功拔管无显著相关性.肺不张,二氧化碳水平升高,和心动过速被确定为拔管失败的危险因素.
BACKGROUND: This study aimed to analyze the use of corticosteroids and epinephrine in neonates for the first
extubation attempt and compared clinical characteristics of infants with successful and failed
extubation events.
METHODS: This was a retrospective cohort study conducted at a single level III neonatal intensive care unit in Taiwan. The study included 215 infants born between 2020 and 2021 who had been intubated for more than 48 h before their first extubation attempt. We compared perinatal and peri-
extubation characteristics and outcomes between the two groups. Successful
extubation was defined as freedom from invasive ventilatory support 72 h after
extubation. The relationship between corticosteroids, local epinephrine, and successful extubation was determined using multivariate logistic regression analysis.
RESULTS: In the univariate analysis, the failed extubation group received a significantly higher proportion of intravenous dexamethasone (p = 0.006) than the successful extubation group. Furthermore, the failed extubation group had a longer duration of nebulized epinephrine (p = 0.034) and more episodes of local application of epinephrine to the superior larynx (p = 0.003) than the successful extubation group. Multivariate analysis revealed that the absence of lung atelectasis, tachycardia 72 h after extubation, and lower post-
extubation PCO2 were the key factors associated with successful
extubation.
CONCLUSIONS: There were trends toward systemic dexamethasone, local application of epinephrine to the superior larynx, and longer duration of nebulized epinephrine in the reintubation group. However, corticosteroid or local epinephrine use was not significantly associated with successful extubation. Lung atelectasis, elevated levels of carbon dioxide, and tachycardia were identified as risk factors for extubation failure.