喉罩通气在新生儿复苏中的应用和评价  

Application and evaluation of laryngeal mask airway in neonatal resuscitation

作　　者：林冰纯[1] 朱小瑜[1] 苏晋琼[1] 叶鸿瑁[2] 虞人杰[3] 

机构地区：[1]南方医科大学附属深圳市妇幼保健院新生儿科,518028 [2]北京大学第三医院儿科 [3]清华大学附属第一医院儿科

出　　处：《中华围产医学杂志》2010年第5期379-383,共5页Chinese Journal of Perinatal Medicine

基　　金：基金项目：广东省深圳市科技计划项目（200802067）

摘　　要：目的初步观察喉罩通气应用于新生儿复苏的可行性、有效性和安全性。方法将分娩后需正压通气复苏的新生儿369例随机分为喉罩组（205例）及面罩组（164例），比较两种方法的复苏效果及观察喉罩操作时间、一次放置成功率及不良反应等。结果（1）两组新生儿生后1minApgar评分构成差异无统计学意义，生后5rainApgar评分构成高分者喉罩组明显多于面罩组（χ^2＝3．39，P=0．001）。喉罩总体复苏成功率明显高于面罩组（99．02％和84．15％，χ^2=28．76，P〈0．01），总体复苏通气时间明显短于面罩组[（36．4±23．7）S和（66．2±35．4）s]（t=-8．66，P〈0．01）；其中重度窒息患儿喉罩复苏成功率为7／9，面罩组6例均未能成功复苏而需改气管插管；1minApgar评分4～5分的新生儿喉罩复苏成功率明显高于面罩组（100．00％和42．86％，χ^2=23．04，P〈0．01），通气时间短于面罩组[（54．6±33．6）S和（136．4±42．0）s3（t=-4．45，P〈0．01）；1minApgar评分6～7分的新生儿复苏成功率两组差异无统计学意义。（2）喉罩一次放置成功率98．54％（202／205），放置时间平均为（7．8±2．2）s，不良反应有呕吐（4例）和胃食管反流（3例）。结论喉罩通气操作相对简单，容易掌握，在较重窒息患儿中使用效果优于面罩，可在一定程度上替代气管插管，尤其适于气管插管操作不熟练者使用。Objective To study the feasibility, efficacy and safety of laryngeal mask airway （LMA） in neonatal resuscitation. Methods Totally, 369 neonates requiring positive pressure ventilation at birth were randomized into two groups by offering either LMA resuscitation （205 cases） or bag-mask ventilation （BMV） resuscitation （164 cases）. The effect in the two groups were observed. Results （1） No significant difference was observed in Apgar scores at 1 min between LMA group and BMV group, but the neonates having higher Apgar scores at 5 min in LMA group were more than in BMV group （χ^2 =3.39, P=0.001）. The successful resuscitation rate of LMA group was higher than that of BMV group （99.02% vs 84.15% ,χ^2 =28. 76, P〈0.01）, the total ventilation time of LMA group was shorter than that of BMV group [（36.4±23.7） s vs （66.2±35.4） s] （t= -8. 66, P〈0.01）. Among severe asphyxia neonates, seven of nine were successfully resuscitated by LMA, while in BMV group six neonates with severe asphyxia were all switched to endotracheal intubation ventilation. In neonates with Apgar score of 4 to 5 at 1 min after birth, the successful resuscitation rate of LMA group was higher than that of BMV group （100% vs 42. 86%, χ^2 =23.04, P〈0.01）, the ventilation time of LMA group was shorter than that of BMV group [（54.6±33.6） s vs （136.4±42.0） s] （t=-4, 45, P〈0.01）. In neonates with Apgar score of 6 to 7 at 1 min after birth, there was no significant difference in the successful resuscitation rate between LMA and BMV group. （2） The successful rate of LMA insertion at first attempt was 98. 54% （202/205） and the average insertion time was （7.8± 2.2） s. The adverse effects included vomiting（4 cases） and regurgitation （3 cases）. Conclusions In neonatal resuscitation, LMA can be easily inserted. Compared to BMV, LMA is a better choice in resuscitation for neonates with moderate or severe asphyxia and preferable for those medical staffs who are unfamiliar with endot

关 键 词：窒息 新生儿 复苏术 正压呼吸 喉面罩 

分 类 号：R722[医药卫生—儿科]