早产儿喉罩复苏的临床随机对照研究

Laryngeal mask airway usage in resuscitation of premature infants——a randomized controlled study

目的初步探讨喉罩通气应用于早产儿特别是极低出生体重儿复苏的可行性、有效性和安全性。方法选取2011年1月至2012年9月在本院出生后需正压通气复苏,且产前评估胎龄28～34周或体重1000～2000g的早产儿,随机分为喉罩组及面罩组,分析喉罩在早产儿复苏中的技术要点、优势、通气疗效及不良反应等。结果 (1)喉罩组(35例)极低出生体重儿喉罩插入深度及注入气囊气体量均低于低出生体重儿[深度:(6.3±0.9)cm比(7.1±0.9)cm,气体量:(1.2±0.9)ml比(1.7±0.5)ml,P<0.05]。(2)喉罩组复苏成功率明显高于面罩组(88.6%比40.0%),气管插管率较面罩组降低81%[11.4%比60.0%],通气时间短于面罩组[(56.8±24.7)s比(103.6±43.8)s,P<0.05]。两组新生儿生后1 min Apgar评分分布差异无统计学意义[平均秩次39.9比31.1,P>0.05],5 min Apgar评分喉罩组高于面罩组[平均秩次25.3比17.9,P<0.05]。(3)两组复苏成功早产儿复苏前后1h内(脐)动脉血乳酸及微量血糖检测差异无统计学意义,但喉罩组复苏前后(脐)动脉血气PO2差值大于面罩组,差异有统计学意义[(72.1±13.8)mmHg比(64.5±10.0)mmHg,P<0.05]。(4)复苏成功早产儿复苏过程中,喉罩组60s时心率及氧饱和度高于面罩组[心率:(165.2±13.8)次/min比(151.4±16.1)次/min,氧饱和度:(69.6±10.9)%比(60.5±11.5)%,P<0.05]。(5)喉罩组呕吐1例,胃食管反流2例。结论喉罩通气操作相对简单有效,在早产儿中复苏效果明显优于面罩,且在极低出生体重儿中也可安全使用,能显著降低气管插管率。

Objective To study the feasibility, efficacy and safety of （LMA） usage in resuscitation of preterm especially VLBW infants. Methods laryngeal mask airway Total of 70 Preterm infants requiring positive pressure ventilation whose birth weight between 1 kg to 2 kg were randomly assigned into 2 groups ： LMA group （ 35 cases） and bag - mask ventilation （ BMV ） group （ 35 cases）. Key application techniques, advantage and disadvantage of each method, and efficacy of ventilation were observed and compared between the two groups during resuscitation of premature neonates. Results （ 1 ） LMA insertion depth and the cuff volume were significantly lower in VLBW babies than in LBW babies [（6.3±0.9） cmvs. （7.1±0.9）cm, （1.2±0.9） mlvs. （1.7±0.5） ml, P〈0.05]. （2） Notonly the successful resuscitation rate in the LMA group was higher than the BMV group （88.6% vs. 40.0% ） , endotracheal intubation rate was decreased by 81% [ 11.4% in LMA vs. 60.0% in BMV]. The assisted ventilation time in LMA group was shorter than that in BMV group [ （56. 8 ± 24. 7 ） s vs.（ 103.6 ± 43.8 ） s, P 〈 0. 05 ]. Although there was no statistical significant differences in Apgar scores at 1 min between the two groups, higher Apgar scores at 5 min were observed in the LMA group （Mean Rank 25.3 vs. 17.9, P 〈 0.05 ）. （ 3 ） Similarly, no significant difference in serum lactic acid and capillary blood glucose levels were observed between two groups, the post resuscitation umbilical artery blood PO2 level was higher in the LMA group [ （72. 1 ± 13.8） mm Hg vs. （64. 5 ± 10. 0）mm Hg, P 〈 0. 05 ]. （g） Infant heart rate and oxygen saturation after 60 second of resuscitation were also higher in theLMA group [（165.2 ±13.8）bpm vs. （151.4±16.1）bpm , （69.6±10.9）% vs. （60.5 ± 11.5 ）%, P 〈 0. 05 ]. （5） LMA group was well tolerated by premature neonates, only one case of vomiting and two cases of regurgitation were observed in this group. Conclusions LMA is superior to BMA in resuscitation of premature neonates. LMA can be easily inserted, with good efficacy and safety profiles. LMA usage not only can significantly decrease the incidence of intubation, but also can be used safely in VLBW infants.