新生儿皮罗序列征围术期评估及管理  

Perioperative evaluation and management of neonates with Pierre-Robin sequence

作　　者：王萍 尧杰 潘翩翩 邓丽 罗微 周伟 Wang Ping;Yao Jie;Pan Pianpian;Deng Li;Luo Wei;Zhou Wei(Department of Neonatology,Guangzhou Women and Children′s Medical Center,Guangzhou 510000,China)

机构地区：[1]广州市妇女儿童医疗中心新生儿科,510000

出　　处：《中华实用儿科临床杂志》2021年第14期1077-1081,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的总结新生儿期行下颌骨牵引成形术的皮罗序列征患儿的病例特点,为围术期评估和管理提供依据。方法收集2016年12月至2019年12月在广州市妇女儿童医疗中心新生儿科确诊为皮罗序列征的新生儿资料,开展回顾性研究。根据术前需要的呼吸支持种类,分为3组:有创辅助通气组、无创辅助通气组、氧疗/体位疗法组。根据术后使用镇静镇痛药物情况,分为联合镇静镇痛组(枸橼酸芬太尼联用咪达唑仑镇痛镇静)和单用镇静组(单用咪达唑仑)。结果共收治31例患儿,其中接受下颌骨牵引成形术22例,手术年龄为(22.09±8.42)d。术前需有创呼吸机辅助通气组11例,无创辅助通气组5例,氧疗/体位疗法组6例,3组比较,严重气道梗阻比例(81.8%比60.0%比0)、喂养困难比例(100.0%比80.0%比50.0%)差异均有统计学意义(均P<0.05);合并喉软化率(63.6%比20.0%比33.3%)、术前体质量增长不良率(81.8%比80.0%比66.7%)、术后上机时间[(7.5±3.4)d比(7.2±5.3)d比(6.9±4.1)d]和住院时间[(36.3±9.3)d比(34.1±0.3)d比(33.8±7.5)d]差异均无统计学意义(均P>0.05)。术后联合镇静镇痛组9例,单用镇静组13例,联合镇静镇痛组与单用镇静组比较,脱管率低(0比15.4%),住院时间短[(32.3±5.2)d比(39.8±7.3)d],差异均有统计学意义(均P<0.05)。术后上机时间[(7.4±3.9)d比(7.6±4.2)d]比较差异无统计学意义(P>0.05)。术后气道梗阻缓解率为100%。结论皮罗序列征患儿在新生儿期行下颌骨牵引成形术效果良好,严重气道梗阻患儿术后呼吸机支持时间和住院时间较轻度梗阻患儿无需延长,术后镇静镇痛管理可降低脱管率。Objective To summarize the clinical characteristics of neonates with Pierre-Robin sequence(PRS)who received mandibular distraction osteogenesis(MDO),in order to provide a basis for perioperative evaluation and management.Methods Data of neonates diagnosed with PRS and receiving MDO in the Department of Neonatology,Guangzhou Women and Children′s Medical Center between December 2016 and December 2019 were collected for a retrospective study.According to the types of respiratory support needed before surgery,they can be categorized into 3 groups:the invasive ventilation group,the noninvasive ventilation group,the oxygen therapy/positioning therapy group.According to the usage of sedative and analgesic drugs after surgery,they were categorized into 2 groups:the sedative-analgesic group(Fentanyl Citrate and Midazolam)and the single sedative group(Midazolam alone).Results A total of 31 children were admitted,22 cases of whom received MDO at an age of(22.09±8.42)d,including 11 cases in the invasive ventilation group,5 cases in the non-invasive ventilation group,and 6 cases in the therapy/positioning therapy group before surgery;there was statistical significance in severe respiratory distress(81.8%vs.60.0%vs.0)and feeding difficulties(100.0%vs.80.0%vs.50.0%)among the 3 groups(all P<0.05),while there was no difference in laryngomalacia rate(63.6%vs.20.0%vs.33.3%),non-gain in weight before surgery(81.8%vs.80.0%vs.66.7%),postoperative ventilation duration[(7.5±3.4)d vs.(7.2±5.3)d vs.(6.9±4.1)d]and hospital stay[(36.3±9.3)d vs.(34.1±0.3)d vs.(33.8±7.5)d](all P>0.05).Among these 22 patients,there were 9 cases in the sedative-analgesic group,and 13 cases in the single sedative group.Compared with the single sedative group,cases in the sedative-analgesic group had significantly lower extubation rate(0 vs.15.4%)and shorter hospital stay[(32.3±5.2)d vs.(39.8±7.3)d],and the difference were statistically significant(all P<0.05).Besides,there were no differences in postoperative ventilation duration[(7.4±3.9)d vs.(7.6±

关 键 词：皮罗序列征 下颌骨牵引成形术 围术期 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]