中文摘要：

目的 探讨气管插管-注入肺泡表面活性物质（pulmonary surfactant,PS）-拔管后经鼻持续正压通气（intubation-surfactant-extubation,INSURE）策略在极/超早产儿中应用失败的危险因素.方法 选取2005年1月至2014年12月本院新生儿重症监护室应用INSURE策略治疗的胎龄＜32周早产儿临床资料,根据拔管后72 h内是否再次插管行机械通气,分为INSURE策略成功组和失败组,采用x2检验、t检验比较两组患儿基本情况及转归,并行多因素Logistic回归分析INSURE策略失败的独立危险因素.结果 研究期间本院共收治胎龄＜ 32周早产儿1 149例,其中生后立即应用INSURE策略治疗患儿148例,成功113例,失败35例,成功率为76.4％.INSURE策略失败组男性比例、动脉二氧化碳分压、母亲年龄均明显高于成功组,胎龄、出生体重、产前应用糖皮质激素比例、动脉氧分压、动脉氧分压/吸入氧浓度比值均明显低于成功组（P＜0.05）.Logistic回归分析显示男性（OR=7.440,95％CI1.846 ～29.984）、出生体重＜1 000 g（OR =9.180,95％ CI1.716 ～49.105）、动脉二氧化碳分压＞48 mmHg（OR =5.996,95％ CI2.088 ～ 17.213）、动脉氧分压/吸入氧浓度＜205（OR=3.010,95％ CI1.033～8.774）是INSURE策略失败的独立危险因素（P均＜0.05）.结论 INSURE策略失败与患儿性别、胎龄、出生体重、母亲年龄、产前应用糖皮质激素比例、生后第一次血气分析指标等因素有关,其中男性、出生体重＜1 000 g、生后第一次血气动脉二氧化碳分压＞48 mmHg、动脉氧分压/吸入氧浓度＜ 205是INSURE策略失败的独立危险因素.

英文摘要：

Objective To study the risk factors for failure of INSURE strategy in very and extremely low birth weight preterm （V/ELBW） infants.Method From January 2005 to December 2014,clinical data of 149 preterm infants （gestational age less than 32 weeks） admitted to neonatal department of Tongji Hospital who received intubation-surfactant-extubation （INSURE） strategy were collected.These infants were assigned into two groups：INSURE failure group and INSURE success group,according to whether a second dose of surfactant or mechanical ventilation was needed within 72 hours after first pulmonary surfactant treatment.The clinical characteristics and outcomes between the two groups were compared.Chi square and t tests were used to define the differences between groups.Logistic regression analysis was used to identify the independent risk factors for INSURE failure.Result Among the 1 149 patients,148 received INSURE treatment,and 113 cases （76.4%） were successfully treated with the INSURE strategy.The infants in the failure group were statistically lower in birth weight,gestation age,antenatal steroids utilization rate,PaO2 and PaO2/FiO2 than those in the success group,while the age of mother,male/female ratio and PaCO2 were higher in the failure group.Logistic regression analysis showed that male （OR =7.440,95% CI 1.846 ～29.984）,BW 〈 1 000 g （OR =9.180,95% CI 1.716 ～49.105）,PaCO2 〉48 mmHg （OR =5.996,95% CI 2.088 ～ 17.213）,PaO2/FiO2 〈205 （OR =3.010,95% CI 1.033 ～8.774） were independent risk factors for INSURE failure.Conclusion INSURE strategy failure was associated with gender,birth weight,gestation age,antenatal steroids utilization,PaO2,PaCO2 and PaO2/FiO2 of the first blood gas after birth.BW 〈 1 000 g,PaCO2 〉 48 mmHg and PaO2/FiO2 〈 205 of the first blood gas after birth were independent risk factors for INSURE strategy failure.