CAJ | 학술논문

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1 minApgar评分构成差异无统计学意义,生后5 min Apgar评分构成高分者喉罩组明显多于面罩组(x2=-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%,x2=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;1 minApgar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%,x2=23.04,P＜0.01),通气时间短于面罩组[(54.6±33.6)s和(136.4±42.0)s](t=-4.45,P＜0.01);1 minApgar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.
목적 초보관찰후조통기응용우신생인복소적가행성、유효성화안전성. 방법장분면후수정압통기복소적신생인369례수궤분위후조조(205례)급면조조(164례),비교량충방법적복소효과급관찰후조조작시간、일차방치성공솔급불량반응등. 결과 (1)량조신생인생후1 minApgar평분구성차이무통계학의의,생후5 min Apgar평분구성고분자후조조명현다우면조조(x2=-3.39,P=0.001).후조총체복소성공솔명현고우면조조(99.02%화84.15%,x2=28.76,P＜0.01),총체복소통기시간명현단우면조조[(36.4±23.7)s화(66.2±35.4)s](t=-8.66,P＜0.01);기중중도질식환인후조복소성공솔위7/9,면조조6례균미능성공복소이수개기관삽관;1 minApgar평분4～5분적신생인후조복소성공솔명현고우면조조(100.00%화42.86%,x2=23.04,P＜0.01),통기시간단우면조조[(54.6±33.6)s화(136.4±42.0)s](t=-4.45,P＜0.01);1 minApgar평분6～7분적신생인복소성공솔량조차이무통계학의의.(2)후조일차방치성공솔98.54%(202/205),방치시간평균위(7.8±2.2)s,불량반응유구토(4례)화위식관반류(3례). 결론후조통기조작상대간단,용역장악,재교중질식환인중사용효과우우면조,가재일정정도상체대기관삽관,우기괄우기관삽관조작불숙련자사용.
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 (x2 =-3. 39,P=0. 001). The successful resuscitation rate of LMA group was higher than that of BMV group (99.02%vs 84. 15% ,x2 =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%, x2 =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 endotracheal intubation, or even as a substitute of endotracheal intubation ventilation.