T组合复苏器在产房中对极早产儿复苏的应用效果初步评价

摘要

目的 探讨T组合复苏器在产房中对极早产儿复苏的临床效果.方法 选择我院2010年1月至2015年12月出生的极早产儿(胎龄28～ 31周),出生后经初步复苏有正压通气指征者纳入本研究.将纳入对象随机分为T组合复苏器组及复苏囊组,观察两组患儿气管插管复苏率、机械通气时间、持续气道正压通气时间、鼻导管吸氧时间、总用氧时间,以及气胸、败血症、坏死性小肠结肠炎、支气管肺发育不良、早产儿视网膜病、颅内出血、动脉导管未闭发生率.采用独立样本t检验和X2检验比较两组的差异.结果 共纳入51例极早产儿,其中复苏囊组25例,T组合复苏器组26例.两组患儿性别、胎龄、出生体重、Apgar评分、分娩方式、产前激素的使用等方面差异均无统计学差意义(P＞0.05).与复苏囊组相比,T组合复苏器组气管插管复苏率降低(15.4％比44.0％),机械通气时间和总用氧时间均缩短[(4.2±2.8)d比(10.1±4.3)d,(36.2±14.7)d比(47.2±19.2)d],差异有统计学意义(P＜0.05).两组持续气道正压通气时间、鼻导管吸氧时间,以及气胸、败血症、坏死性小肠结肠炎、支气管肺发育不良、早产儿视网膜病、颅内出血、动脉导管未闭发生率差异无统计学意义(P＞0.05).结论 与复苏囊复苏相比,T组合复苏器复苏可降低产房极早产儿气管插管复苏率,缩短机械通气时间和总用氧时间.%Objective To study the efficacy of T-piece resuscitator on the very preterm infants in the delivery room.Method Very preterm infants (gestational age 28 ～ 31 weeks) who needed positive pressure ventilation during delivery room resuscitation were included in the study between January 2010 and December 2015.Enrolled infants were randomly assigned to self-inflating bag group and T-piece group.Tracheal intubation ratio,duration of mechanical ventilation,continuous positive airway pressure (CPAP),supplementary oxygen through a nasal cannula and total oxygen requirement were compared between groups.The percentages of pneumothorax,sepsis,necrotizing enterocolitis (NEC),bronchopulmonary dysplasia (BPD),retinopathy of prematurity (ROP),intracranial hemorrhage and patent ductus arteriosus (PDA) between groups were also compared.Data were analyzed using independent sample t test and chi-square test.Result A total of 51 preterm infants were enrolled in this study,with 25 infants in the self-inflating bag group and 26 in the T-piece group.There was no statistically significant difference in the gender,gestational age,birth weight,Apgar scores,delivery mode and antenatal glucocorticoids between the two groups (P ＞ 0.05).The ratio of intubation in T-piece group was significantly lower than that in self-inflating bag group (15.4％ vs.44.0％,P ＜ 0.05).Further more,duration of mechanical ventilation and total oxygen requirement in the T-piece group were significantly shorter than those in the self-inflating bag group [(4.2±2.8) dvs.(10.1 ±4.3) d,(36.2±14.7) dvs.(47.2±19.2) d,P＜0.05].However,the duration of nasal CPAP and supplementary oxygen through a nasal cannula,the rate of pneumothorax,sepsis,NEC,BPD,ROP,intracranial hemorrhage and PDA did not differ significantly between groups (P ＞ 0.05).Conclusion Compared with the self-inflating bag group,the use of the T-piece in delivery room decrease the rate of tracheal intubation and the duration of mechanical ventilation and total oxygen requirement.