应用胎粪吸引管气管内吸引防治胎粪吸入综合征的临床效果分析

Endotreacheal suction immediately after birth for preventing meconium aspiration syndrome

目的评价气管内吸引防治胎粪吸入综合征（meconium aspiration syndrome，MAS）的有效性，探讨新生儿活力与胎粪吸入的关系。方法2004年1月至2006年12月我院分娩胎粪Ⅲ度污染新生儿（简称粪染儿）495例，随机分为观察组249例，生后常规气管插管、应用胎粪吸引管抽吸胎粪；对照组246例，生后插管、气管内冲洗。观察两组MAS发生率、并发症及预后。结果观察组与对照组MAS发生率分别为7．6％和11．4％（X^2=2．45，P〉0．05）；观察组重型MAS发生率明显低于对照组[0．8％（2／249）和4．5％（11／246），X^2=6．51，P〈0．05]；观察组机械通气率为0．4％，对照组为2．8％（X^2=3．12，P〉0．05）；观察组病死率为0，对照组病死率1．2％（3／246）。观察组1min Apgar评分9～10分有活力新生儿气管抽出胎粪中位数为0．86ml，明显少于≤8分无活力新生儿的1．65ml（Z=1．44，P〈0．05）；观察组有活力粪染儿中17．8％（38／214）气管内可抽到胎粪，其中26．3％（10／38）可抽出大量胎粪。结论（1）粪染儿生后早期进行气管内吸引不能减少MAS发生率，但可减轻临床症状，防止并发症，降低病死率。（2）有活力新生儿亦可发生胎粪吸入，应积极处理。

Objective To determine if endotracheal intubation and suction of the airways of meconium-stained babies at birth is more beneficial in preventing meconium aspiration syndrome （MAS） than endotracheal intubation and lavage, and to study the relationship of the incidence of meconium aspiration with vigorous of infants at birth. Methods Four hundred and ninety-five infants born through thick meeonium-stained amniotic fluid were randomized to either suction group or lavage group from Jan. 2004 to Dec. 2006. Infants were routinely endotreacheal intubated at birth, 249 infants of the suction group were aspirated after flapping back and postural drainage and 246 infants of the lavage group were treated with tracheobronchial lavage with saline. The morbidities, complication and prognosis of MAS were compared between the two groups. Results The incidence of MAS was 7.6% and 11.4% in the suction group and the lavage group respectively （X^2 =2.45, P〉 0.05）. But the incidence of severe MAS was significant lower in the suction group （0.8%, 2/249） than in the lavage group （4.5%, 11/246） （X^2 =6.51, P〈0.05）. The rate of mechanical ventilation was similar between the two groups （0.4% vs 2.8%, X^2 =3.12, P〉0.05）. No infants died in the the suction group, but 3 infants died in the lavage group （fatality rate 1.2 %）. The mean meconiumstained fluid aspirated was about 0.86 ml and 1.65 ml respectively for infants of Apgar scoring 9-10 and 48 in the suction group and there was statistical significant difference between the two groups （Z =1.44, P〈0. 05）. Thirty-eight of 214 infants （17.8%） with vigorous in the suction group had meconium-stained fluid aspirated and 10 in 38 infants （26.3 %） had a great volume of fluid aspirated from their airway. Conelusions Endotracheal intubation and suction of the airways at birth in meconium-stained babies cannot reduce the morbidity of MAS, but it can prevent the complication and reduce the mortality of MAS. The viable newborns should also be treated actively for potential MAS.