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、肺出血、肾损伤、NEC发生率比较差异无统计学意义(P>0.05)。结论产房内复苏质量的改进可以改善胎龄<32周早产儿的近期临床结局,提高早产儿生存质量。
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 than that in the control group,and the utilization rate of CPAP was significantly higher than that in the control group(P<0.05);there was no significant difference in the utilization rate of epinephrine and chest compression of premature infants between the two groups(P>0.05).The average temperature of the premature infants in the observation group was 0.4℃higher than that in the control group when they were transferred to NICU,and there was significant difference in average temperature of patients between the two groups(P<0.05);the proportion of premature infants with mild hypothermia and proportion of premature infants with normal body temperature in the observation group were significantly higher than those in the control group,and the proportion of premature infants with moderate hypothermia was significantly lower than that in the control group(P<0.05).The utilization rate of mechanical ventilation within 24 hours of admission in the observation group was significantly lower than that in the control group,the total ventilation time and hospitalization time were significantly shorter than those in the control group(P<0.05).There was no significant difference in pH value,lactic acid level,blood glucose level and utilization rate of PS of premature infants between the observation group and the control group(P>0.05).The incidences of pneumothorax,myocardial damage,SAH,hypothyroidism and liver injury of premature infants in the observation group were significantly lower than that in the control group(P<0.05);there was no significant difference in the incidences of BPD,pulmonary hemorrhage,renal injury and NEC of premature infants between the two groups(P>0.05).Conclusion The improved intra-parturient resuscitation quality can improve the short-term clinical outcome of premature infants less than 32 weeks of gestational age,and improve the quality of life of the premature infants.
作者
武俊宝
刘玉霞
李超
耿向阳
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)
出处
《新乡医学院学报》
CAS
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)。
关键词
复苏质量
用氧管理
体温管理
早产儿
quality of resuscitation
oxygen management
temperature management
premature infant
