新生儿喉罩复苏效果及远期神经心理发育评估
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摘要
目的 追踪评价应用喉罩复苏的新生儿神经心理发育情况。方法 对中山市博爱医院妇幼保健院2012年4月至2016年10月期间符合入选标准,经过初步复苏后需要实施正压通气的新生儿共259例,随机分为喉罩组118例及面罩组141例。新生儿出院时建立高危儿随访档案,由高危儿随访中心专人负责随访。体格发育监测指标为身长、体重、头围,采用生长发育曲线图。神经运动评价:6月龄和12月龄时用Gesell婴幼儿发育检查量表检测发育商(DQ)。结果 ①复苏的效果:喉罩组一次性成功置入116例(98.31%),置入时间为(7.5±2.1)s,无不良反应;喉罩组复苏成功率(98.31%)超过面罩组(85.81%),差异有统计学意义(P=0.001);喉罩组起效时间[(11.61±5.29)s vs.(32.34±19.02)s]和通气时间[(32.91±15.67)s vs.(74.52±35.65)s]均明显短于面罩组(t值分别为11.335、11.761,均P<0.001)。②随访率:随访到6个月为56.37%(146/259),随访到12个月为39.00%(101/259),其中早产儿占55.45%(56/101)。③脑瘫发生率:喉罩组为2.54%(3/118),面罩组为5.67%(8/141),两组比较差异无统计学意义(P>0.05)。④神经心理发育评估:喉罩组及面罩组6月龄和12月龄时5个能区比较均无统计学差异(均P>0.05);6月龄和12月龄时喉罩组平均发育商分别为(92.54±17.38)、(96.86±12.61),面罩组分别为(89.36±22.67)、(93.22±16.52),两组比较均无统计学差异(均P>0.05)。结论 相比面罩,喉罩的通气效果好,操作相对简便,对婴儿远期神经心理发育无不良影响,可作为新生儿复苏一种有效的选择。
Objective To follow up the evaluation of neuropsychological development in neonatal resuscitation with laryngeal mask airway. Methods During April 2012 to October 2016, a total of 259 neonates who met the inclusion criteria and needed positive pressure ventilation after initial resuscitation were randomly divided into laryngeal mask group(118 cases) and face mask group(141 cases). The follow-up files of high-risk infants were established when the neonates were discharged from hospital. And the special persons from the follow-up center of high-risk infants were assigned to conduct the follow-up. Physical development monitoring indicators were length, weight and head circumference, and growth and development curve was used. For neuromotoxic evaluation, developmental quotient(DQ) was measured by Gesell Infant Development Checklist at 6 months and 12 months of age. Results In terms of resuscitation effect, a total of 116 cases(98.31%) in laryngeal mask group were successfully implanted at first attempt, and the implantation time was(7.5±2.1)s, and there was no adverse reaction. The success rate of resuscitation in laryngeal mask group(98.31%) was significantly higher than that in face mask group(85.81%)(P=0.001). The onset time and ventilation time in laryngeal mask group were [(11.61±5.29) s] and [(32.91± 15.67) s], which were significantly shorter than those in face mask group [(32.34± 19.02) s] and [(74.52±35.65) s](t value was 11.335 and 11.761, respectively, both P<0.001). At the 6 th month of age, the follow-up rate was 56.37%(146/259) and at 12 th month that was 39.00%(101/259). Among all the infants followed up, the premature infants accounted for 55.45%(56/101). Incidence of cerebral palsy in laryngeal mask group was 2.54%(3/118) while that in face mask group was 5.67%(8/141). The difference between two groups was not statistically significant(P>0.05). In the aspect of neuropsychological development assessment, there were no significant differences between laryngeal mask group and face mask group in the results of 5 functional regions at 6 months and 12 months of age(P>0.05). For infants at 6 months old and 12 months old, the mean DQ values of the two groups were 92.54±17.38 and 89.36±22.67, and 96.86±12.61 and 93.22±16.52. There was no statistical difference between two groups(both P>0.05). Conclusion Compared with face mask, laryngeal mask has good ventilation effect, relatively simple operation, and no adverse effect on infant's long-term neuropsychological development, and it can be used as an effective choice for neonatal resuscitation.
Objective To follow up the evaluation of neuropsychological development in neonatal resuscitation with laryngeal mask airway. Methods During April 2012 to October 2016, a total of 259 neonates who met the inclusion criteria and needed positive pressure ventilation after initial resuscitation were randomly divided into laryngeal mask group(118 cases) and face mask group(141 cases). The follow-up files of high-risk infants were established when the neonates were discharged from hospital. And the special persons from the follow-up center of high-risk infants were assigned to conduct the follow-up. Physical development monitoring indicators were length, weight and head circumference, and growth and development curve was used. For neuromotoxic evaluation, developmental quotient(DQ) was measured by Gesell Infant Development Checklist at 6 months and 12 months of age. Results In terms of resuscitation effect, a total of 116 cases(98.31%) in laryngeal mask group were successfully implanted at first attempt, and the implantation time was(7.5±2.1)s, and there was no adverse reaction. The success rate of resuscitation in laryngeal mask group(98.31%) was significantly higher than that in face mask group(85.81%)(P=0.001). The onset time and ventilation time in laryngeal mask group were [(11.61±5.29) s] and [(32.91± 15.67) s], which were significantly shorter than those in face mask group [(32.34± 19.02) s] and [(74.52±35.65) s](t value was 11.335 and 11.761, respectively, both P<0.001). At the 6 th month of age, the follow-up rate was 56.37%(146/259) and at 12 th month that was 39.00%(101/259). Among all the infants followed up, the premature infants accounted for 55.45%(56/101). Incidence of cerebral palsy in laryngeal mask group was 2.54%(3/118) while that in face mask group was 5.67%(8/141). The difference between two groups was not statistically significant(P>0.05). In the aspect of neuropsychological development assessment, there were no significant differences between laryngeal mask group and face mask group in the results of 5 functional regions at 6 months and 12 months of age(P>0.05). For infants at 6 months old and 12 months old, the mean DQ values of the two groups were 92.54±17.38 and 89.36±22.67, and 96.86±12.61 and 93.22±16.52. There was no statistical difference between two groups(both P>0.05). Conclusion Compared with face mask, laryngeal mask has good ventilation effect, relatively simple operation, and no adverse effect on infant's long-term neuropsychological development, and it can be used as an effective choice for neonatal resuscitation.
引文
[1]中国新生儿复苏项目专家组.新生儿复苏指南(2016年北京修订)[J].中华围产医学杂志,2016,19(7):481-486.
[2]余志碧,朱小瑜,叶鸿瑁,等.喉罩在新生儿复苏应用中的循证医学研究进展[J].中华医学围产杂志,2015,18(1):67-69.
[3]Benumof J.Laryngeal mask airway and the ASA difficult airway Mgorithrn[J].Anesthesiology,1996,84:686-699.
[4]Paterson S J,Byme P J,Molesky M G,et al.Neonatal resuscitation using the laryngeal mask airway[J].Anesthesiology,1994,80:1248-1253.
[5]American Heart Association,American Academy of Pediatrics.2005 American Heart Association(AHA)guidelines for cardiopulmonary resuscitation(CPR)and emergency cardiovascular care(ECC)of pediatric and neonatal patients:neonatal resuscitation guidelines[J].Pediatrics,2006,117:e1029-1038.
[6]广东省围产医学新生儿喉罩复苏课题协作组.新生儿喉罩复苏效果的多中心随机对照临床研究[J].中华围产医学杂志,2014,17(8):546-552.
[7]高建慧,赖春华,邹志慧,等.喉罩气道在新生儿复苏中的建立与临床效果分析[J].中国新生儿科杂志,2015,30(1):16-19.
[8]赖春华,高建慧,邹志慧,等.国产喉罩与进口喉罩用于新生儿复苏的临床效果比较[J].中华围产医学杂志,2015,18(10):17-20.
[9]Zanardo V,Weiner G,Micaglio M,et al.Deliveryroom resuscitation of near-term infants:role of the laryngeal mask airway[J].Resucitation,2010,81:327-330.
[10]ZhuX Y,Lin B C,Zhang Q S,et al.A prospective evaluation of the efficacy of the laryngeal mask airway during neonatal resuscitation[J].Resuscitation,2011,82:1405-1409.
[11]高建慧,张晓敏,杨冰岩,等.对新生儿窒息新法复苏实施强化培训效果的评价[J].中华围产医学杂志,2007,10(4):234-237.
[2]余志碧,朱小瑜,叶鸿瑁,等.喉罩在新生儿复苏应用中的循证医学研究进展[J].中华医学围产杂志,2015,18(1):67-69.
[3]Benumof J.Laryngeal mask airway and the ASA difficult airway Mgorithrn[J].Anesthesiology,1996,84:686-699.
[4]Paterson S J,Byme P J,Molesky M G,et al.Neonatal resuscitation using the laryngeal mask airway[J].Anesthesiology,1994,80:1248-1253.
[5]American Heart Association,American Academy of Pediatrics.2005 American Heart Association(AHA)guidelines for cardiopulmonary resuscitation(CPR)and emergency cardiovascular care(ECC)of pediatric and neonatal patients:neonatal resuscitation guidelines[J].Pediatrics,2006,117:e1029-1038.
[6]广东省围产医学新生儿喉罩复苏课题协作组.新生儿喉罩复苏效果的多中心随机对照临床研究[J].中华围产医学杂志,2014,17(8):546-552.
[7]高建慧,赖春华,邹志慧,等.喉罩气道在新生儿复苏中的建立与临床效果分析[J].中国新生儿科杂志,2015,30(1):16-19.
[8]赖春华,高建慧,邹志慧,等.国产喉罩与进口喉罩用于新生儿复苏的临床效果比较[J].中华围产医学杂志,2015,18(10):17-20.
[9]Zanardo V,Weiner G,Micaglio M,et al.Deliveryroom resuscitation of near-term infants:role of the laryngeal mask airway[J].Resucitation,2010,81:327-330.
[10]ZhuX Y,Lin B C,Zhang Q S,et al.A prospective evaluation of the efficacy of the laryngeal mask airway during neonatal resuscitation[J].Resuscitation,2011,82:1405-1409.
[11]高建慧,张晓敏,杨冰岩,等.对新生儿窒息新法复苏实施强化培训效果的评价[J].中华围产医学杂志,2007,10(4):234-237.