Supreme喉罩与经典型喉罩应用于新生儿复苏的比较

Supreme and classic laryngeal mask airway in neonatal resuscitation

目的探讨Supreme喉罩气道（laryngeal mask airway SupremeTM，SLMA）应用于新生儿复苏的可行性、有效性和安全性。方法2012年6月1日至2013年6月1日，在南方医科大学附属深圳妇幼保健院出生的新生儿中，纳入胎龄≥34周或出生体重≥2 000 g、生后经30 s初步复苏处理仍有正压通气指征的新生儿共60例，随机分为经典型喉罩气道（laryngeal mask airway ClassicTM，CLMA）组和SLMA组各30例。比较2组喉罩使用情况、复苏效果、生化指标、心率及经皮脉搏氧饱和度（pulse oxygen saturation，SpO2）以及不良反应的发生情况。采用独立样本t检验、非参数检验及χ^2检验进行统计学分析。结果CLMA组与SLMA组的插入时间分别为（7.6±1.3）与（4.9±1.0） s（t=8.98），移位的比例分别为13.3%（4/30）与0%（0/30）（Fisher精确概率法），SLMA组均低于CLMA组（P值均〈0.05）。CLMA组与SLMA组复苏成功的比例分别为90.0%（27/30）与100.0%（30/30）（Fisher精确概率法），起效时间分别为（15.6±3.8）与（12.4±3.7） s（t=3.31），通气时间分别为（48.2±20.1）与（37.3±17.0） s（t=2.29），SLMA组均优于CLMA组（P值均〈0.05）。CLMA组与SLMA组生后1 min的心率分别为（74.2±17.8）与（93.5±20.9）次/min，生后1、2、3 min的经皮SpO2分别为（38.7±12.1）%与（47.1±8.4）%、（52.8±10.8）%与（68.1±9.5）%、（72.1±9.7）%与（78.3±10.0）%，SLMA组均高于CLMA组（t值分别为－3.86、－3.13、－5.82和－2.46，P值均〈0.05）。SLMA组无一例发生呕吐或反流、腹胀、胃部积气、喉部损伤。CLMA组3例发生呕吐或反流，2例出现腹胀，7例出现胃部积气，无一例喉部损伤。结论SLMA操作较CLMA更为简单，密闭性好，不良反应少，复苏效果优越，可减少气管插管率，在新生儿复苏中有很大应用潜能。

Objective To study the feasibility, efficacy and safety of laryngeal mask airway （LMA） Supreme （SLMA） in neonatal resuscitation. Methods Sixty neonates, who were born at South Medical University Affiliated Maternal ＆ Child Health Hospital of Shenzhen from June 1, 2012 to June 1, 2013 and requiring positive pressure ventilation after 30 s primary resuscitation post born, with birth weight above 2 000 g or gestational age above 34 weeks, were randomly assigned into two groups： SLMA group （n=30） and LMA Classic （CLMA） group （n=30）. The outcome indicators included the curative effect, insertion time and possible adverse reactions of the two kinds of LMA, and the serum bio-markers, heart rate and percutaneous pulse oxygen saturation （SpO2） of all neonates. Independent sample t test, non-parametric test and Chi-square test were applied for statistical analysis. Results The insertion time was shorter in SLMA group tlran in CLMA group [（4.9±1.0） vs （7.6±1.3） s, t=8.98, P〈0.05]. And more displacement occurred in CLMA group than in SLMA group [13.3% （4/30） vs 0% （0/30）, Fisher exact test, P〈0.05]. The successful rate of resuscitation in SLMA group was higher [100.0% （30/30） vs 90.0% （27/30）, Fisher＇s exact test, P〈0.05], and both the onset time and the total ventilation time were shorter than those in CLMA group [（12.4±3.7） vs （15,6±3.8） s, t=3.31, P〈0.05; （37.3±17.0） vs （48.2±20.1） s, t=2.29, P〈0.05]. The heart rate at 1 min after delivery was higher in SLMA group than in CLMA group [（93.5±20.9） vs （74.2±17.8） bpm, t= - 3.86, P〈0.05], and the same results were shown for SpO2 at 1, 2 and 3 rain after birth [（47.1±8.4）% vs （38.7±12.1）%, t = 3.13; （68.1 ±9.5）% vs （52.8± 10.8）%, t=- 5.82; （78.3±10.0）% vs （72.1±9.7）%, t=- 2.46; all P〈0.05]. in the CLMA group, vomit or regurgitation occurred in three neonates, abdominal distension in two cases, aerogastria in seven cases. However, none of the above was reported in the SLMA group. No laryngeal injury was found in any of the subjects. Conclusion SLMA is more potential than CLMA in neonatal resuscitation because of its simplicity, better airtight, less adverse effect, superior efficacy and less requirement for tracheal intubation.