To investigate predictors of non-invasive positive pressure ventilation (NIPPV) failure in children with severe pneumonia using propensity score matching. A retrospective case-control study included 79 children with severe pneumonia who experienced NIPPV failure at the Children's Hospital of Chongqing Medical University from January 2021 to December 2023 and 118 contemporaneous children who had successful NIPPV. Propensity score matching was used for 1∶1 matching on baseline variables. Multivariable logistic regression analysis was performed to identify predictors of NIPPV failure, and receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of selected variables. After matching, 77 patients were included in each group, with no statistically significant differences in baseline characteristics (P>0.05). Multivariable logistic regression showed that respiratory rate (OR=1.109) and heart rate (OR=1.064) at 12-24 hours after NIPPV, Pediatric Early Warning Score (PEWS) score before NIPPV (OR=2.809), and lung consolidation on chest imaging before NIPPV (OR=16.144) were positive predictors of NIPPV failure (all P<0.05). Pulse oxygen saturation (SpO2) at 12-24 hours after NIPPV was a negative predictor of NIPPV failure (OR=0.414, P<0.05). ROC analysis showed that SpO2 at 12-24 hours after NIPPV predicted NIPPV failure with an area under the curve (AUC) of 0.906, sensitivity of 70.1%, specificity of 98.7%, and an optimal cutoff of 92%. The PEWS score before NIPPV predicted NIPPV failure with an AUC of 0.784, sensitivity of 64.9%, specificity of 84.4%, and an optimal cutoff of 3.5 points. In children with severe pneumonia receiving NIPPV, close monitoring of respiratory rate, heart rate, and SpO2 is essential, and risk stratification for treatment failure should incorporate pre-treatment chest imaging findings (consolidation area) and PEWS score. 目的: 基于倾向性评分匹配法探究儿童重症肺炎无创正压通气（non-invasive positive pressure ventilation, NIPPV）失败的预测因素。方法: 采用回顾性病例对照研究方法，选取2021年1月—2023年12月重庆医科大学附属儿童医院79例重症肺炎NIPPV失败患儿作为病例组，并抽取同期118例NIPPV成功患儿作为对照组。采用倾向性评分匹配法对两组的基线资料进行1∶1匹配。采用多因素logistic回归分析探究NIPPV失败的预测因素，并绘制受试者操作特征曲线评估部分因素的预测效能。结果: 匹配后两组均包括77例患儿，基线资料比较差异均无统计学意义（P>0.05）。多因素logistic回归分析显示，NIPPV 12~24 h后呼吸频率（OR=1.109）和心率（OR=1.064），以及NIPPV前儿童早期预警评分（Pediatric Early Warning Score, PEWS）得分（OR=2.809）和肺部影像学显示肺实变（OR=16.144）是NIPPV失败的正向预测因素（均P<0.05），而NIPPV 12~24 h后脉搏血氧饱和度（pulse oxygen saturation, SpO2）是NIPPV失败的负向预测因素（OR=0.414，P<0.05）。受试者操作特征曲线分析显示，NIPPV 12~24 h后SpO2预测重症肺炎NIPPV失败的曲线下面积为0.906，灵敏度和特异度分别为70.1%和98.7%，最佳截断值为92%;NIPPV前PEWS得分预测重症肺炎NIPPV失败的曲线下面积为0.784，灵敏度和特异度分别为64.9%和84.4%，最佳截断值为3.5分。结论: 重症肺炎患儿NIPPV治疗中应密切监测呼吸、心率、SpO2等基础生命体征变化，并结合治疗前肺部影像学表现（肺实变面积）、PEWS得分进行NIPPV失败的风险分层。.
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