肌松剂在早产儿非急诊气管插管前的应用  

Premedication of Muscle Relaxant for Non-Urgency Intubation in Prematurity

作　　者：程锐[1] Brigitte Lemyre 

机构地区：[1]南京医科大学附属南京市儿童医院新生儿科,南京210008 [2]渥太华大学附属总医院NICU

出　　处：《实用儿科临床杂志》2009年第24期1910-1912,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨肌松剂-司可林在早产儿(<34周)非急诊气管插管前应用的安全性和疗效。方法将2007年1-7月在加拿大渥太华大学附属渥太华总医院和东安大略省儿童医院NICU行非急诊气管插管的早产儿,在共同应用芬太尼和阿托品的基础上,分为肌松剂组(A组,予阿托品、芬太尼,加用司可林);非肌松剂组(B组,仅用阿托品、芬太尼)。根据统一的气管插管程序,比较一次插管成功率、插管的总次数、插管人水平、Goldberg评分及不良反应。采用t检验和χ2检验行统计学分析。结果共44例患儿纳入研究,A组25例,B组19例,2组一般情况无统计学差异。A组一次插管成功率为56.0%(14例),B组为21.1%(4例),2组比较具有统计学差异(P<0.05)。A组平均插管次数[(1.8±1.3)次]低于B组[(2.5±1.3)次],A组Goldberg评分[(4.3±2.0)分]低于B组[(4.7±1.8)分],A组口鼻腔出血例数[5例(20.0%)]多于B组[2例(10.5%)],A组心动过缓(心率<100次/min)者[6例(24.0%)]少于B组[6例(31.6%)],A组氧饱和度<80%者[16例(64.0%)]少于B组[15例(78.9%)],A组皮囊加压给氧困难者[3例(12.0%)]少于B组[6例(31.6%)],但2组比较均无统计学差异(Pa>0.05)。结论阿托品、芬太尼、司可林联合用药,安全可靠,能提高一次插管成功率,避免反复插管引起的声门损伤,有利于年轻医师快速掌握气管插管术。Objective To investigate the safety and efficiency of using Succinylcholine as premedication for non-urgency intubation in prematurity.Methods During Jan.to Jul.2007,in Ottawa General Hospital and Children＇s Hospital of Eastern Ontario NICU,the prematurity who were received non-urgency intubation were divided into 2 groups as premedication group（group A）and non-premedication group（group B）.Premedications in group A were applied Atropine,Fentanyl and Succinylcholine;premedications in group B were applied Atropine and Fentanyl.The same procedures were done according to the protocol in 2 groups.The basical information,one attempt successful intubation,total attempts,Goldberg scores and side effects were compared between both groups.Results Forty-four cases were involved in the study,25 cases in group A,19 cases in group B,there was no significant difference in patients＇ basical information between both groups.One attempt successful intubation was 56.0%（14 cases）in group A,higher than that in group B [21.1%（4 cases）],which had significant diffe-rence between 2 groups（P0.05）.Average attempts of each patient in group A（1.8±1.3）was lower than that in group B（2.5±1.3）,Goldberg score in group A（4.3±2.0）was lower than that in group B（4.7±1.8）,mouth or nose bleeding in group A [5 cases（20.0%）] was higher than that in group B[2 cases（10.5%）],bradyrhythmia（heart rate100 times per minute）in group A[24.0%（6 cases）] was lower than that in group B[31.6%（6 cases）],desatuation（80%）in group A [64.0%（16 cases）]was lower than that in group B[78.9%（15 cases）],hard bagging in group A[12.0%（3 cases）] was lower than that in group B[31.6%（6 cases）],but there were no significant differences between both groups（Pa0.05）.Conclusions Atropine,Fentanyl and Succinylcholine are safe as the premedication used in prematurity,which can improve one attempt successful intubation avoiding glottal injury of repeating attempts.It also can helps young physician to be fa

关 键 词：非急诊气管插管 插管前用药 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科]