产房内复苏质量改进对胎龄<32周早产儿近期临床结局的影响  

Effect of improved intra-parturient resuscitation quality on short-term clinical outcomes in preterm infants<32 weeks of gestational age

作　　者：武俊宝 刘玉霞 李超[3] 耿向阳[1] WU Junbao;LIU Yuxia;LI Chao;GENG Xiangyang(The Fourth Clinical Faculty of Xinxiang Medical University,Xinxiang 453003,Henan Province,China;Neonatal Intensive Care Unit,Xinxiang Central Hospital,Xinxiang 453003,Henan Province,China;Xinxiang Medical University,Xinxiang 453003,Henan Province,China)

机构地区：[1]新乡医学院第四临床学院,河南新乡453003 [2]新乡市中心医院新生儿重症监护室,河南新乡453003 [3]新乡医学院,河南新乡453003

出　　处：《新乡医学院学报》2022年第8期735-740,共6页Journal of Xinxiang Medical University

基　　金：河南省医学科技攻关计划项目(编号:LHGJ20191318);河南省高等学校重点科研项目(编号:20B320017)。

摘　　要：目的探讨产房内复苏质量改进对胎龄<32周早产儿近期临床结局的影响。方法选择2018年1月至2021年6月于新乡市中心医院产科出生并转入新生儿重症监护室(NICU)治疗的196例胎龄<32周早产儿为研究对象,根据复苏措施将研究对象分为对照组(n=102)和观察组(n=94)。对照组早产儿给予常规产房内复苏。观察组早产儿在原有保暖基础上增加塑料薄膜保温;对有自主呼吸、呼吸困难的早产儿出生后尽早使用T组合复苏器进行面罩正压通气,对无自主呼吸的早产儿使用T组合复苏器进行气管插管正压通气。比较2组早产儿持续气道正压(CPAP)、气管插管、胸外按压、肾上腺素等应用情况,入NICU时的体温、乳酸、pH值、血糖和肺表面活性物质(PS)使用率,入院24 h内机械通气使用率、总通气时间、住院时间,以及肺出血、气胸、支气管肺发育不良(BPD)、原发性蛛网膜下腔出血(SAH)、心肌损害、甲状腺功能减退、肝损害、肾损害、坏死性小肠结肠炎(NEC)、早产儿视网膜病变(ROP)等并发症发生情况。结果观察组早产儿产房气管插管使用率显著低于对照组,CPAP使用率显著高于对照组(P<0.05);2组早产儿应用肾上腺素使用率、胸外按压使用率比较差异无统计学意义(P>0.05)。观察组早产儿转入NICU时平均体温较对照组升高0.4℃,2组早产儿平均体温比较差异有统计学意义(P<0.05);观察组轻度低体温、正常体温早产儿比例显著高于对照组,中度低体温早产儿比例显著低于对照组(P<0.05)。观察组早产儿入院24 h内机械通气比例显著低于对照组,总通气时间、住院时间显著少于对照组(P<0.05)。观察组与对照组早产儿的pH值、乳酸、血糖、PS使用率比较差异无统计学意义(P>0.05)。观察组早产儿的气胸、心肌损害、SAH、甲状腺功能减退、肝损伤发生率显著低于对照组(P<0.05);观察组与对照组早产儿的BPD、肺出�Objective To investigate the effect of improved intra-parturient resuscitation quality on the short-term clinical outcomes of premature infants less than 32 weeks of gestational age.Methods A total of 196 premature infants with gestational age less than 32 weeks who were born in the Department of Obstetrics,Xinxiang Central Hospital from January 2018 to June 2021 and transferred to neonatal intensive care unit(NICU)for treatment were selected as the research objects.According to the resuscitation measures,the premature infants were divided into control group(n=102)and observation group(n=94).The premature infants in the control group were given routine intrapartum resuscitation.The premature infants in the observation group were kept warm with plastic film on the basis of the original warmth preservation;and the premature infants with spontaneous breathing and dyspnea were treated with T-combination resuscitator for face mask positive pressure ventilation as soon as possible after birth;the premature infants without or no spontaneous breathing were treated with T-combination resuscitator for tracheal intubation positive pressure ventilation.The application of continuous positive airway pressure(CPAP),endotracheal intubation,chest compressions and adrenaline of premature infants were compared between the two groups;and the body temperature,lactic acid,pH value,and blood glucose when entering NICU,and the application ratio of pulmonary surfactant(PS),proportion of mechanical ventilation within 24 hours of admission,total ventilation time,and hospitalization time of premature infants were compared between the two groups;the complications including pulmonary hemorrhage,pneumothorax,bronchopulmonary dysplasia(BPD),primary subarachnoid hemorrhage(SAH),myocardial damage hypothyroidism,liver damage,kidney damage,necrotizing enterocolitis(NEC),retinopathy of prematurity(ROP)were compared between the two groups.Results The rate of tracheal intubation in the delivery room in the observation group was significantly lower tha

关 键 词：复苏质量 用氧管理 体温管理 早产儿 

分 类 号：R722.12[医药卫生—儿科]