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目的初步探讨喉罩通气应用于早产儿特别是极低出生体重儿复苏的可行性、有效性和安全性。方法选取2011年1月至2012年9月在本院出生后需正压通气复苏,且产前评估胎龄28～34周或体重1000～2000g的早产儿,随机分为喉罩组及面罩组,分析喉罩在早产儿复苏中的技术要点、优势、通气疗效及不良反应等。结果 (1)喉罩组(35例)极低出生体重儿喉罩插入深度及注入气囊气体量均低于低出生体重儿[深度:(6.3±0.9)cm比(7.1±0.9)cm,气体量:(1.2±0.9)ml比(1.7±0.5)ml,P<0.05]。(2)喉罩组复苏成功率明显高于面罩组(88.6%比40.0%),气管插管率较面罩组降低81%[11.4%比60.0%],通气时间短于面罩组[(56.8±24.7)s比(103.6±43.8)s,P<0.05]。两组新生儿生后1 min Apgar评分分布差异无统计学意义[平均秩次39.9比31.1,P>0.05],5 min Apgar评分喉罩组高于面罩组[平均秩次25.3比17.9,P<0.05]。(3)两组复苏成功早产儿复苏前后1h内(脐)动脉血乳酸及微量血糖检测差异无统计学意义,但喉罩组复苏前后(脐)动脉血气PO2差值大于面罩组,差异有统计学意义[(72.1±13.8)mmHg比(64.5±10.0)mmHg,P<0.05]。(4)复苏成功早产儿复苏过程中,喉罩组60s时心率及氧饱和度高于面罩组[心率:(165.2±13.8)次/min比(151.4±16.1)次/min,氧饱和度:(69.6±10.9)%比(60.5±11.5)%,P<0.05]。(5)喉罩组呕吐1例,胃食管反流2例。结论喉罩通气操作相对简单有效,在早产儿中复苏效果明显优于面罩,且在极低出生体重儿中也可安全使用,能显著降低气管插管率。
Objective To investigate the feasibility, effectiveness and safety of laryngeal mask ventilation in resuscitation of premature infants, especially those with very low birth weight. Methods From January 2011 to September 2012 in our hospital need positive pressure ventilation recovery, and prenatal assessment of gestational age 28 to 34 weeks or weight 1000 ~ 2000g premature children were randomly divided into laryngeal mask group and mask group , Analysis of laryngeal mask in the recovery of premature children technical points, advantages, ventilation and adverse reactions. Results (1) The laryngeal mask group (35 cases) with low birth weight had the lowest insertion depth of laryngeal mask and the amount of air injected into the balloon (P <0.05) Amount: (1.2 ± 0.9) ml vs (1.7 ± 0.5) ml, P <0.05]. (2) The success rate of resuscitation in laryngeal mask group was significantly higher than that in mask group (88.6% vs. 40.0%), intubation rate was 81% lower than mask group (11.4% vs. 60.0%), and ventilation time was shorter than mask group (56.8 ± 24.7) s ratio (103.6 ± 43.8) s, P <0.05]. There was no significant difference in Apgar score distribution between the two groups at 1 min after birth (mean rank 39.9 vs. 31.1, P> 0.05). Apgar score at 5 min was higher in the mask group than in the mask group [mean rank 25.3 vs 17.9, P < 0.05]. (3) There was no significant difference in arterial blood lactic acid and trace blood glucose within 1 hour before and after resuscitation in two groups of resuscitation before and after resuscitation, but the difference of PO2 between arterial blood before and after resuscitation in laryngeal mask group was greater than that in mask group Significance [(72.1 ± 13.8) mmHg (64.5 ± 10.0) mmHg, P <0.05]. (4) Resuscitation In the course of resuscitation of premature infants, the laryngeal mask group had higher heart rate and oxygen saturation at 60s than the mask group [heart rate: (165.2 ± 13.8) times / min (151.4 ± 16.1) times / min, oxygen saturation (69.6 ± 10.9)% vs (60.5 ± 11.5)%, P <0.05]. (5) laryngeal mask group vomiting in 1 case, gastroesophageal reflux in 2 cases. Conclusions Laryngeal mask ventilation is relatively simple and effective. It has a better resuscitation effect than mask in preterm infants and safe use in very low birth weight children, which can significantly reduce the rate of tracheal intubation.