新生兒窒息復蘇的循證分析_《中國循證醫學雜志》

作者：

廖志 ¹ , 萬朝敏 ²

1. 四川省婦幼保健院,四川省婦女兒童醫院新生兒科,成都,6100312. 四川大學華西二院兒科,成都,610041;

關鍵詞：

新生兒窒息復蘇系統評價隨機對照試驗臨床證據

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目的　評價不同復蘇方法和不同藥物、氧療、物理療法等對新生兒窒息復蘇和復蘇后的預防措施的有效性和安全性.
方法　計算機檢索Cochrane Library(2004年第3期),MEDLINE(1966～2002年) 關于新生兒窒息復蘇時不同復蘇方法、氧氣的應用、以及不同藥物、劑量、給藥途徑治療和預防新生兒窒息的系統評價、隨機和半隨機對照試驗.
結果　正壓通氣時使用100%氧氣和應用室內空氣的復蘇效果并無差異.胎糞污染羊水(MSAF)與較高的新生兒缺血缺氧性腦病(HIE)的發生率有關,而氣管內有胎糞者無論稀稠均與胎糞吸入綜合征發生率無關.窒息復蘇后預防性給予亞低溫療法、抗驚厥藥、納洛酮、多巴胺等在降低新生兒病死率,繼發HIE的嚴重程度等方面與對照組相比無顯著差異.應用肺表面活性物質(PS)預防和治療新生兒呼吸窘迫綜合征(RDS),可減少死亡率和并發癥.
結論　應用PS預防和治療RDS可明顯減少新生兒死亡率,且胎齡 lt;32周的早產兒預防用藥比治療用藥效果更好;目前尚無充分證據證明窒息復蘇后預防性給予亞低溫療法、抗驚厥藥、納洛酮、多巴胺等治療的有效性.

引用本文： 廖志,萬朝敏. 新生兒窒息復蘇的循證分析. 中國循證醫學雜志, 2004, 04(9): 648-651. doi: 復制

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1. ［1］Saugsted OD, Rootwelt T, Aalen O. Resuscitation of asphyxiated infants with room air or oxygen:an international controlled trial: the resair 2 study[J]. Pediatrics, 1998; 102(1): 130.
2. ［2］Tan A, Schulze A, O’Donnell CPF, Davis PG. Air versus oxygen for resuscitation of infants at birth (Cochrane Review)[M/CD]. In: The Cochrane Library, Issue 3, 2004.
3. ［3］Pierce J, Gaudier FL, Sanchez-Ramos L. Intrapartum amino infusion for meconium-aab2stained fluid: meta-analysis of prospective clinical trials[J]. Obstet Gynecol, 2000; 95: 1 051.
4. ［4］Wiswell TE. Expanded uses of surfactant therapy[J]. Clin Perinatol, 2001; 28: 695.
5. ［5］Ziino AJA, Davies MW, Davis PG. Epinephrine for the resuscitation of apparently stillborn or extremely bradycardic newborn infants (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.
6. ［6］Paradisis M, Osborn DA. Adrenaline for prevention of morbidity and mortality in preterm infants with cardiovascular compromise (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.
7. ［7］Yeo CL, TickhopeDI. Outcome of resuscitated apparently stillborn: a ten years review [J]. J Pediatr Child Health, 1994; 30: 129.
8. ［8］Osborn DA, Evans N. Early volume expansion for prevention of morbidity and mortality in very preterm infants (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.
9. ［9］Askie LM, Henderson-Smart DJ. Early versus late discontinuation of oxygen in preterm or low birth weight infants (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.
10. ［10］Chen ZL, Xu HQ. Application ofcurrent resuscitation in delivery room [J]. Journal of Neonatology (Chinese), 1992; 7(1): 56.
11. ［11］Jacobs S, Hunt R, Tarnow-Mordi W, Inder T, Davis P. Cooling for newborns with hypoxic ischaemic encephalopathy (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.
12. ［12］Zhou WH, Xiao M, Zhang XD. Selecting cooling temperature of head for heart function inasphyxited newborns [J]. Chinese Journal of Pediatrics, 2003; 41(6): 460-462.
13. ［13］Thoresen M, Wyatt J. Keeping a cool head, posthypoxic hypothermia-an old idea revisted [J]. Acta Paediatr, 1997; 86(10): 1 029.
14. ［14］Yanamoto H, Nakahara I. Combination of intraischemia and postischemia and persistent neuroprotection against temporary focal ischemia in rat [J]. Stroke, 1999; 30(12): 2 720.
15. ［15］Evans DJ, Levene MI. Anticonvulsants for preventing mortality and morbidity in full term newbones with perinatal asphyxia (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.
16. ［16］Lotze A,Mitcbell BR, Bulas DI, et al. Multicenter study of surfactant (beractant) use in the treatment of term infants with severe respiratory failure [J]. J Pediatr, 1998; 132: 40.
17. ［17］Wiswell TE, Knight GR, Finer NN. A multicenter, randomized, controlled trial comparing Surfaxin (Lucinactant) lavage with standard care for treatment of meconium aspiration syndrome [J]. Pediatrics,2002; 9(6): 1 081.
18. ［18］Egbert J, Brand R, Walti H. Mortality,severe respiratory distress syndrome and chronic lung disease of the newborn are reduced more after the prophylactic than after the therapeutic administration of the surfactant curosurf [J]. Pediatrics, 1997; 100: 1e4.
19. ［19］Soll RF. Synthetic surfactant for respiratory distress syndrome in preterm infants (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.
20. ［20］McGuire W, Fowlie PW, Evans DJ. Naloxone for preventing morbidity and mortality in newborn infants of greater than 34 weeks’ gestation with suspected perinatal asphyxia (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.
21. ［21］Hunt R, Osborn D. Dopamine for prevention of morbidity and mortality in term newborn infants with suspected perinatal asphyxia (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.

《中國循證醫學雜志》

新生兒窒息復蘇的循證分析

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《中國循證醫學雜志》

新生兒窒息復蘇的循證分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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