无活力新生儿气管插管吸引胎粪的回顾性队列研究

A retrospective cohort study of tracheal intubation for meconium suction in nonvigorous neonates

摘要:

目的 探讨胎粪污染羊水（meconium stained amniotic fluid，MSAF）无活力新生儿生后立即进行气管插管吸引胎粪的可行性。 方法 采用队列研究方法，回顾性收集柘城县人民医院入住新生儿科MSAF无活力病例，2017年7月1日至2018年6月30日无吸引胎粪条件病例为对照组，2018年7月1日至2019年6月30日吸引胎粪病例为吸引组。分析比较新生儿胎粪吸入综合征（neonatal meconium aspiration syndrome，MAS）、新生儿持续性肺动脉高压、气胸、肺出血的发生率及病死率。 结果 共纳入对照组80例，吸引组71例。两组MAS（11% vs 7%）、新生儿肺动脉高压（5% vs 4%）、气胸（3% vs 1%）及死亡（0% vs 1%）的发生率差异无统计学意义（P>0.05）。吸引组需吸氧（16% vs 33%）、无创呼吸支持（25% vs 41%）和机械通气（10% vs 23%）的患儿比例低于对照组（P<0.05），无创呼吸机时间［（58±24）h vs（83±41）h］、住院时间［6（4，8）d vs 7（5，10）d］短于对照组（P<0.05）。 结论 MSAF无活力新生儿生后立即气管插管吸引胎粪可减少出现轻度呼吸问题的呼吸支持时间，但并不能降低MAS发生率、病死率及严重并发症发生率。

Abstract:

Objective To study the feasibility of tracheal intubation for meconium suction immediately after birth of nonvigorous neonates born through meconium-stained amniotic fluid (MSAF). Methods A retrospective cohort study was performed on nonvigorous neonates born through MSAF who were admitted to the Department of Neonatology, Zhecheng People's Hospital. The neonates without meconium suction who were admitted from July 1, 2017 to June 30, 2018 were enrolled as the control group. The neonates who underwent meconium suction from July 1, 2018 to June 30, 2019 were enrolled as the suction group. The two groups were compared in terms of the mortality rate and the incidence rates of neonatal meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn, pneumothorax, and pulmonary hemorrhage. Results There were 80 neonates in the control group and 71 in the suction group. There were no significant differences between the two groups in the incidence rates of MAS (11% vs 7%), persistent pulmonary hypertension of the newborn (5% vs 4%), pneumothorax (3% vs 1%), and death (0% vs 1%). Compared with the control group, the suction group had a significantly lower proportion of neonates requiring oxygen inhalation (16% vs 33%, P<0.05), noninvasive respiratory support (25% vs 41%, P<0.05) or mechanical ventilation (10% vs 23%, P<0.05) and significantly shorter duration of noninvasive ventilation [(58±24) hours vs (83±41) hours, P<0.05] and length of hospital stay [6(4, 8) days vs 7(5, 10) days, P<0.05]. Conclusions Although tracheal intubation for meconium suction immediately after birth may shorten the duration of respiratory support for mild respiratory problems, it cannot reduce the incidence rate of MAS, mortality rate, or the incidence rate of serious complications in nonvigorous infants born through MSAF.