喉罩气道在新生儿复苏中的建立与临床效果分析

The establishment and clinical application of laryngeal mask airway during neonatal resuscitation

目的探讨在新生儿复苏中建立喉罩气道的可行性和有效性。方法选择2012年4月至2013年11月在我院分娩、经过初步复苏后需要正压通气的新生儿,按出生日期奇偶数分喉罩组和面罩组,观察喉罩成功插入时间及1次成功放置率,比较两组复苏成功率、复苏起效时间和通气时间。结果 (1)喉罩组57例,面罩组42例,两组患儿胎龄、出生体重、分娩方式、高危因素差异均无统计学意义(P>0.05),喉罩组男性多于女性,差异有统计学意义(P<0.05)。(2)成功插入喉罩所需时间(7.5±2.1)s,1次放置成功率98.2%;喉罩组复苏成功率(98.2%),明显高于面罩组(85.7%),差异有统计学意义(P<0.05);喉罩组起效时间和需要通气时间均明显短于面罩组[(11.5±5.5)s比(32.1±19.3)s,(32.9±21.9)s比(74.5±89.1)s,P<0.05]。两组1 min Apgar评分差异无统计学意义(P>0.05),喉罩组5 min Apgar评分高分者多于面罩组,差异有统计学意义(P<0.05)。结论在新生儿复苏中,喉罩气道的建立简单、安全、有效,复苏效果优于面罩,可降低气管插管率,是一种适合在临床中广泛推广应用的复苏方法。

Objective To study the feasibility and effectiveness of the application of laryngeal mask airway （LMA） during neonatal resuscitation.Methods From April 2012 to November 2013,newborns born in our hospital and required positive pressure ventilation after initial resuscitation were enrolled and assigned to LMA group or to bag-mask ventilation （BMV） group according to date of birth.We evaluated the duration of successful LMA insertion and the rate of successful insertion at the first attempt.The rate of successful resuscitation,onset time and duration of ventilation between the two groups were also compared.Results （1） Fifty-seven infants were assigned to LMA group and 42 infants were assigned to BMV group.There were no significant differences of gestational age,birth weight,the mode of delivery and high risk factors between the two groups.The sex ratio of LMA group was higher than that of the BMV group （P ＜ 0.05）.（2） It took （7.5 ± 2.1） sec to insert the LMA successfully.The rate of successful insertion at the first attempt was 98.2％.The rate of successful resuscitation of the LMA group （98.2％） was higher than that of the BMV group （85.7％） （P ＜ 0.05）.Newborns who received LMA resuscitation,as compared with newborns who received BMV resuscitation,required fewer seconds to get improved [onset time：（11.5 ±5.5） s vs.（32.9 ±21.9） s,P ＜0.001],and required fewer seconds of ventilation [（32.1 ± 19.3） s vs.（74.5 ± 89.1） s,P =0.001].Although the Apgar score at one minute after delivery were similar between the groups,however,the 5-minute Apgar score of the infants assigned to LMA group was higher than that of the infants assigned to BMV group （P ＜ 0.05）.Conclusions During resuscitation of newborns,the application of LMA is convenient,safe,and more effective than BMV as a lower rate of intubation.The results of this study support consideration of LMA as an alternative to BMV in neonatal resuscitation.