【摘要】 目的 通过Meta分析系统评价儿科重症监护病房（PICU）机械通气患儿拔管失败的危险因素，为早期识别高风险人群及制定预防措施提供科学依据。方法 计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、 Web of Science、Embase、Cochrane Library,检索时限为建库至2024年12月16日，由2名研究者独立进行文献的筛选与数据提取，采用RevMan 5.4软件进行Meta分析。结果 共纳入29篇文献，包含19项相关危险因素，Meta分析结果显示，年龄<24个月、拔管后喘鸣、呼吸系统疾病、机械通气时间≥44 h、美国胸外科医师协会-欧洲心胸外科协会（STAT）4～5级手术、男性、气道异常、染色体综合征、神经系统疾病、使用激素、咳嗽反射微弱、镇静剂使用时间>5 d、自主呼吸试验（SBT）失败、拔管后无创通气、遗传综合征、吸入氧浓度分数（FiO₂）>40%、格拉斯哥昏迷评分（GCS）<10分、循环系统疾病以及既往有再插管史为PICU机械通气患儿拔管失败的独立危险因素。结论 PICU机械通气患儿拔管失败受多种因素影响，医护人员应加强对危重患儿的监测与管理，早期识别拔管失败的高风险人群，及时采取有效措施减少拔管失败的发生率，提高PICU患儿的生存率，改善其生活质量。更多还原

【Abstract】 Objective To systematically evaluate the risk factors for extubation failure in pediatric intensive care unit（PICU） children undergoing mechanical ventilation through a Meta-analysis, providing a scientific basis for early identification of high-risk populations and the formulation of preventive measures. Methods A computerized search was conducted in databases including CNKI, Wanfang, VIP, China Biology Medicine（CBM）, PubMed, Web of Science, Embase, and Cochrane Library, covering the period from the establishment of each database to December 16, 2024. Two researchers independently performed literature screening and data extraction. RevMan 5.4 software was used for the Meta-analysis. Results A total of 29 studies were included, encompassing 19 relevant risk factors. The Meta-analysis revealed that the following factors were independent risk factors for extubation failure in PICU children undergoing mechanical ventilation: age <24 months, post-extubation stridor, respiratory diseases, mechanical ventilation duration ≥44 hours, The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Mortality Categories（STAT） surgical grades 4-5, male, airway abnormalities, chromosomal syndromes, neurological diseases, corticosteroid use, weak cough reflex, duration of sedative use >5 days, failure of spontaneous breathing trial（SBT）, post-extubation noninvasive ventilation, genetic syndromes, fraction of inspired oxygen（FiO₂）> 40%, Glasgow Coma Scale（GCS） score<10, circulatory system diseases, and a history of previous reintubation. Conclusion Extubation failure in PICU children undergoing mechanical ventilation is influenced by multiple factors. Healthcare professionals should strengthen monitoring and management of critically ill children, identify high-risk populations early for extubation failure, promptly implement effective measures to reduce the incidence of extubation failure, improve the survival rate of PICU children, and enhance their quality of life.更多还原