目的 探讨无创通气联合振动筛网雾化吸入肺表面活性物质（pulmonary surfactant, PS）技术治疗早产儿呼吸窘迫综合征（respiratory distress syndrome, RDS）的疗效及失败的预测因素。 方法 前瞻性收集2023年6月—2024年11月12家医院新生儿重症监护病房收治的RDS早产儿为研究对象（胎龄>28周、出生体重>1 000 g）。所有患儿均采用经鼻持续气道正压通气予以初始呼吸支持，并通过振动筛网雾化吸入PS治疗，根据是否需要改为经气管插管机械通气分为失败组和成功组。采用多因素logistic回归分析探讨振动筛网雾化吸入PS治疗失败的预测因素，并构建预测模型，通过受试者操作特征曲线及曲线下面积评价该模型对治疗失败的预测效能。 结果 最终纳入126例RDS早产儿，其中成功组107例（84.9%），失败组19例（15.1%）。多因素logistic回归分析显示，产前未规范使用糖皮质激素、出生1 min Apgar低评分、胸部X线检查显示RDS≥Ⅲ级、给药后30 min动脉血氧分压（partial pressure of arterial oxygen, PaO₂）与吸入氧浓度（fraction of inspired oxygen, FiO₂）的比值（PaO₂/FiO₂）较低是振动筛网雾化吸入PS治疗RDS失败的独立预测因素（均P<0.05）。基于这4个因素构建的治疗失败的预测模型的曲线下面积为0.857（95%CI：0.789~0.943），灵敏度为84.21%，特异度为74.53%（出生1 min Apgar评分和给药后30 min PaO₂/FiO₂的截断值分别为<8分、<220 mmHg）。 结论 无创通气联合振动筛网雾化吸入PS技术治疗胎龄>28周、出生体重>1 000 g早产儿RDS的成功率较高。产前未规范使用糖皮质激素、出生1 min Apgar评分<8分、胸部X线检查显示RDS≥Ⅲ级及给药后30 min PaO₂/FiO₂<220 mmHg是该技术治疗失败的独立预测因素。

Objective To evaluate the efficacy of noninvasive ventilation combined with vibrating mesh nebulization of pulmonary surfactant (PS) in preterm infants with respiratory distress syndrome (RDS) and to identify predictors of treatment failure. Methods Preterm infants with RDS (gestational age >28 weeks, birth weight >1 000 g) admitted to neonatal intensive care units at 12 hospitals between June 2023 and November 2024 were prospectively enrolled. All infants initially received nasal continuous positive airway pressure and were treated with PS administered via vibrating mesh nebulization. Infants were categorized into a success group or a failure group according to whether escalation to invasive mechanical ventilation via endotracheal intubation was required. Multivariable logistic regression was used to identify predictors of failure of vibrating mesh nebulized PS treatment. A prediction model was constructed, and its performance was assessed using receiver operating characteristic (ROC) curves and the area under the curve (AUC). Results A total of 126 preterm infants with RDS were included, with 107 (84.9%) in the success group and 19 (15.1%) in the failure group. Multivariable logistic regression analysis showed that nonstandard antenatal glucocorticoid use, a lower 1-minute Apgar score, chest radiograph showing RDS grade ≥III, and a lower ratio of partial pressure of arterial oxygen (PaO₂) to fraction of inspired oxygen (FiO₂) (PaO₂/FiO₂) at 30 minutes after treatment were independent predictors of treatment failure (P<0.05). The prediction model for treatment failure based on these four factors yielded an AUC of 0.857 (95%CI: 0.789-0.943), with a sensitivity of 84.21% and a specificity of 74.53%. The cutoff values for the 1-minute Apgar score and PaO₂/FiO₂ at 30 minutes after treatment were <8 and <220 mmHg, respectively. Conclusions Noninvasive ventilation combined with vibrating mesh nebulization of PS achieves a high success rate in preterm infants with RDS who had a gestational age >28 weeks and a birth weight >1 000 g. Nonstandard antenatal glucocorticoid use, a 1-minute Apgar score <8, chest radiograph showing RDS grade ≥III, and PaO₂/FiO₂ <220 mmHg at 30 minutes after treatment are independent predictors of treatment failure.