新生儿转运团队参与双胎新生儿转运前救治的临床价值  

Clinical value of neonatal transport team participating in the management of twin neonates before transport

作　　者：郭玉婷 郭果 张雪峰 Guo Yuting;Guo Guo;Zhang Xuefeng(Department of Paediatrics,the Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第五医学中心儿科,北京100039

出　　处：《中国小儿急救医学》2023年第6期445-450,共6页Chinese Pediatric Emergency Medicine

摘　　要：目的探讨双胎新生儿出生后由专业新生儿转运团队参与出生后复苏、救治及转运的必要性及临床意义。方法选取2017年1月至2021年12月收治于解放军总医院第五医学中心新生儿科的双胎新生儿,根据新生儿转运团队是否参与出生复苏及救治分为参与组(n=136例)和病例组(n=162例)。对两组双胎新生儿出生后采取的复苏措施、Apgar评分、转运过程中呼吸支持情况、入院时基本情况、入院后首次动脉血气情况、住院期间并发症情况、住院时间、转归等资料进行回顾性分析。结果与病例组双胎新生儿相比,参与组转运前行气管插管治疗的比例较高(5.88%比0.62%,χ^(2)=6.997,P=0.013),入院时间更短[48(7,115)min比87(47,425)min,Z=-11.593,P<0.001],入院时发生低氧状况的比例较低(9.56%比17.90%,χ^(2)=4.250,P=0.039),经皮血氧饱和度更高[96(86,100)%比95(85,100)%,Z=-7.274,P<0.001],入院首次血气氧分压更高[(91.02±25.77)mmHg比(87.82±25.23)mmHg,t=1.076,P=0.008],入院时低体温发生率更低(36.03%比47.53%,χ^(2)=4.008,P=0.045),两组比较差异均有统计学意义(P均<0.05)。参与组危重新生儿比例高于病例组(40.44%比24.07%,χ^(2)=9.172,P=0.002),住院时间[11(4,76)d比9(3,72)d,Z=-2.684,P=0.014]和应用静脉营养时间[7(0,42)d比5(0,40)d,Z=-2.470,P=0.014]均高于病例组,两组比较差异均有统计学意义(P均<0.05)。结论专业的新生儿转运团队参与双胎新生儿转运前救治时在新生儿复苏及后期住院治疗期间起积极作用,可提高双胎新生儿出生时窒息复苏气管插管成功率,新生儿转运至NICU治疗所需时间更短,可降低转运过程中低氧血症及入院后低氧状况、低体温的发生率;助产医院医护人员需加强高危新生儿窒息复苏的专业培训,提高窒息复苏及新生儿气管插管技术的熟练度,加强对双胎新生儿出生后护理。Objective To investigate and analyze the necessity and clinical significance of professional neonatal transport team participating in post-natal resuscitation,management and transport of twin neonates after birth.Methods A total of 298 cases of twin neonates admitted to the Department of Neonatology at the Fifth Medical Center of PLA General Hospital from January 2017 to December 2021 were selected.According to whether the neonatal transport team participated in birth resuscitation and management,they were divided into participation group(n=136)and case group(n=162).The resuscitation measures taken after birth,Apgar score,respiratory support during transport,basic information at admission,the first arterial blood gas after admission,complications during hospitalization,length of stay and outcome of the two groups of twins were retrospectively analyzed.Results Compared with twins in case group,the proportion of tracheal intubation before transport was significantly higher in participation group(5.88%vs.0.62%,χ^(2)=6.997,P=0.013),hospital admissions were significantly shorter[48(7,115)min vs.87(47,425)min,Z=-11.593,P<0.001],and significantly lower rates of hypoxia on admission(9.56%vs.17.90%,χ^(2)=4.250,P=0.039),significantly higher percutaneous oxygen saturation[96(86,100)%vs.95(85,100)%,Z=-7.274,P<0.001],and higher blood-gas-oxygen partial pressure on admission[(91.02±25.77)mmHg vs.(87.82±25.23)mmHg,t=1.076,P=0.008]were found.The incidence of hypothermia on admission was significantly lower(36.03%vs.47.53%,χ^(2)=4.008,P=0.045),and the differences between two groups were statistically significant(P<0.05).The proportion of critically ill neonates(40.44%vs.24.07%,χ^(2)=9.172,P=0.002),length of hospital-stay[11(4,76)d vs.9(3,72)d,Z=-2.684,P=0.014]as well as the intravenous nutrition time[7(0,42)d vs.5(0,40)d,Z=-2.470,P=0.014]in participaton group were significantly higher than those in case group,and there were statistically significant differences between two groups(P<0.05).Conclusion Professional neonatal tra

关 键 词：双胎新生儿 新生儿转运 新生儿复苏 新生儿气管插管 

分 类 号：R722.1[医药卫生—儿科]