Maheshwari Rajesh, Tracy Mark, Badawi Nadia, Hinder Murray
Department of Neonatology, Westmead Hospital, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2016 May;52(5):480-6. doi: 10.1111/jpc.13192.
Neonatal endotracheal intubation is commonly accompanied by significant disturbances in physiological parameters. The procedure is often poorly tolerated, and multiple attempts are commonly required before the airway is secured. Adverse physiological effects include hypoxemia, bradycardia, hypertension, elevation in intracranial pressure and possibly increase in pulmonary vascular resistance. Use of premedications to facilitate intubation has been shown to reduce but not eliminate these effects. Other important preventative factors include adequate training of the operators and guidelines to limit the duration of attempts. Pre-intubation stabilisation with optimal bag and mask ventilation should allow for better neonatal tolerance of the procedure. Recent research has described significant mask leak and airway obstruction compromising efficacy of neonatal mask ventilation. Further research should help in elucidating mask ventilation techniques which minimise mask leak and airway obstruction.
新生儿气管插管通常会伴随着生理参数的显著紊乱。该操作往往耐受性较差，在确保气道安全之前通常需要多次尝试。不良生理效应包括低氧血症、心动过缓、高血压、颅内压升高以及可能的肺血管阻力增加。已证明使用插管前用药可减少但不能消除这些效应。其他重要的预防因素包括对操作人员的充分培训以及限制尝试持续时间的指南。采用最佳的面罩和面罩通气进行插管前稳定处理应能使新生儿对该操作有更好的耐受性。最近的研究描述了显著的面罩漏气和气道阻塞会损害新生儿面罩通气的效果。进一步的研究应有助于阐明能将面罩漏气和气道阻塞降至最低的面罩通气技术。
