气管内与肌注纳洛酮用于新生儿重度窒息复苏的临床研究

Clinical Trial of Endotracheal Versus Intramuscular Injection of Naloxone in Serious Neonatal Asphyxia Resuscitation

目的：探讨经气管内与肌注纳络酮对新生儿重度窒息复苏的效果。方法：40例产后重度窒息的新生儿,随机分为气管内组（ET组,n=20）和肌注组（IM组,n=20）。两组行气管插管后：（1）ET组经气管内注入纳洛酮0.2mg·kg-1（以生理盐水稀释至2~3mL）;（2）IM组肌注纳洛酮0.2mg·kg-1。距首次注药后10min两组再分别经气管内、肌注纳洛酮一次,给药剂量在首次剂量基础上减半。两组均同时施行相同综合抢救措施。两组观察记录出生后1min、3min、5min Apgar评分、自主呼吸建立时间、呼吸频率、用药前后的心率变化。结果：（1）ET组3min、5min Apgar评分显著高于IM组（P〈0.05）;（2）ET组与IM组用药后心率与用药前比较均明显增快（P〈0.01、P〈0.05）,但ET组用药后心率又显著快于IM组（P〈0.01）;ET组自主呼吸建立时间明显早于IM组（P〈0.01）,呼吸频率ET组亦显著快于IM组（P〈0.01）。结论：对静脉通路未建立和（或）已作气管插管的新生儿重度窒息患者临床复苏中,经气管内应用较肌注纳洛酮能有效缩短新生儿窒息时间,促使其自主呼吸早期建立。

Objective：To assess the effects of endotracheal versus intramuscular injection of naloxone in serious neonatal asphyxia resuscitation.Methods：A random clinical trial was undertaken in infants with serious asphyxia,of 40 infants with 1-minute Apgar score 1 to 3,20 received an endotracheal injection of naloxone（0.2 mg·kg-1）（endotracheal group,ET group）and 20 received an intramuscular injection（0.2 mg·kg-1）（intramuscular group,IM group）,10 minutes later followed a half dose of naloxone in two group which were performed same treatment after tracheal intubation.The 1-minute,3-minute and 5-minute Apgar score,time of spontaneous respiration,respiration frequency and heart rate were observed.Results：The 3-minute and 5-minute Apgar score were significantly higher in ET group than IM group（P〈0.05）.After naloxone injection,HR in two group was obviously increased as it compared with baseline,and HR in ET group was significantly higher than in IM group.For ET and IM group,the time of spontaneous respiration was 92.4 s and 148.6 s（P〈0.01）,the respiration frequency was 48.5 bpm and 39.4 bpm（P〈0.01）.Conclusions：During the serious neonatal asphyxia resuscitation without an effective venous channel and/or tracheal intubated,the endotracheal delivery of naloxone is more powerful than intramuscular injection,the time of asphyxia and spontaneous respiration were significantly shortened.