摘要
目的调查无创呼吸机通气治疗后新生儿呼吸窘迫综合征(NRDS)患儿鼻损伤发生率,分析鼻损伤发生的影响因素,并针对影响因素制定干预策略。方法回顾性选取2021年2月—2024年6月丽水市中心医院收治的87例经无创呼吸机通气治疗的NRDS患儿为研究对象,统计NRDS患儿鼻损伤的发生情况并分析其临床特征,采用多因素logistic回归分析鼻损伤的影响因素。结果87例NRDS患儿中,鼻损伤发生率为37.93%(33/87),其中有16例发生鼻外观改变,29例发生鼻压力性损伤。发生鼻损伤组出现儿童压疮风险评估量表(Braden Q)评分≤15分(78.79%vs.22.22%)、面部水肿(72.73%vs.38.89%)、出现躁动(66.67%vs.35.19%)、机械通气时间>15 d(69.70%vs.40.74%)、暖箱湿度>65%(63.64%vs.31.48%)的NRDS患儿比例均高于未发生鼻损伤组,差异均有统计学意义(χ^(2)=26.641、9.393、8.147、6.878及8.609,均P<0.05)。多因素logistic回归分析结果显示,Braden Q评分≤15分(OR=2.061)、面部水肿(OR=1.420)、出现躁动(OR=1.531)、机械通气时间>15 d(OR=1.711)及暖箱湿度>65%(OR=1.958)均为经无创呼吸机通气治疗后NRDS患儿鼻损伤发生的危险因素(均P<0.05)。结论NRDS患儿是发生鼻损伤的高危人群,无创呼吸机通气治疗后NRDS患儿发生鼻损伤与其皮肤情况、面部水肿、躁动、机械通气时间及暖箱湿度等因素相关,干预人员应避免患儿发生面部水肿、躁动,及时对皮肤情况进行风险评估并根据风险程度采取预防性干预措施,适当调控暖箱湿度,促进患儿恢复以缩短机械通气时间,降低NRDS患儿鼻损伤发生率。
Objective To investigate the incidence rate of nasal injury in children with neonatal respiratory distress syndrome(NRDS)after noninvasive ventilator ventilation,and analyze the influencing factors of nasal injury,and formulate intervention strategies for related factors.Methods A total of 87 children with NRDS who were treated with noninvasive ventilator ventilation in Lishui Central Hospital from February 2021 to June 2024 were retrospectively selected as study subjects.The occurrence of nasal injury in children with NRDS was counted and the clinical characteristics were analyzed.Multivariate logistic regression analysis was adopted to analyze the influencing factors of nasal injury.Results Among the 87 children with NRDS,the incidence rate of nasal injury was 37.93%(33/87),and there were 16 cases of nasal appearance changes and 29 cases of nasal pressure injury.The proportions of NRDS children with pediatric pressure ulcer risk assess-ment scale(BradenQ)score≤15 points(78.79%vs.22.22%),facial edema(72.73%vs.38.89%),agitation(66.67%vs.35.19%),mechanical ventilation time>15 d(69.70%vs.40.74%)and incubator humidity>65%(63.64%vs.31.48%)in nasal injury group were higher than those in non-nasal injury group(x2=26.641,9.393,8.147,6.878,8.609,all P<0.05).Multivariate logistic regression a-nalysis revealed that BradenQ score≤15 points(OR=2.061),facial edema(OR=1.420),agitation(OR=1.531),mechanical ventilation time>15 d(OR=1.711)and incubator humidity>65%(OR=1.958)were risk factors for nasal injury in NRDS children after noninvasive ventilator ventilation(all P<0.05).Conclusion Children with NRDS were at high risk of nasal injury.The occurrence of nasal injury in children with NRDS after noninvasive ventilator ventilation was related to factors such as skin conditions,facial edema,agitation,mechanical ventilation time and incubator humidity.Intervention personnel should avoid the occurrence of facial edema and agitationin children,timely assess the risk of skin conditions and take preventive intervention measures according to the degree of risk,properly regulate the humidity of incubator,promote the recovery of children to shorten the mechanical ventilation time,and reduce the incidence rate of nasal injury in chil-dren with NRDS.
作者
施海燕
代苗英
卢芳华
SHI Hai-yan;DAI Miao-ying;LU Fang-hua(Department of Neonatology,Lishui Central Hospital,Lishui,Zhejiang 323000,China)
出处
《中国妇幼保健》
2025年第22期4119-4123,共5页
Maternal and Child Health Care of China
基金
浙江省医药卫生科技计划项目(2023RC310)。
关键词
呼吸窘迫综合征
无创呼吸机通气
鼻损伤
干预策略
Respiratory distress syndrome
Noninvasive ventilator ventilation
Nasal injury
Intervention strategies
