出生时早产新生儿使用T型管与自动充气式气囊通气的比较。
T-piece versus self-inflating bag ventilation in preterm neonates at birth.
作者信息
Guinsburg Ruth, de Almeida Maria Fernanda Branco, de Castro Junia Sampel, Gonçalves-Ferri Walusa Assad, Marques Patricia Franco, Caldas Jamil Pedro Siqueira, Krebs Vera Lucia Jornada, Souza Rugolo Ligia Maria Suppo de, de Almeida João Henrique Carvalho Leme, Luz Jorge Hecker, Procianoy Renato S, Duarte José Luiz Muniz Bandeira, Penido Marcia Gomes, Ferreira Daniela Marques de Lima Mota, Alves Filho Navantino, Diniz Edna Maria de Albuquerque, Santos Juliana Paula, Acquesta Ana Lucia, Santos Cristina Nunes Dos, Gonzalez Maria Rafaela Conde, da Silva Regina Pg Vieira Cavalcanti, Meneses Jucile, Lopes José Maria de Andrade, Martinez Franciscó Eulógio
机构信息
Division of Neonatal Medicine, Federal University of São Paulo, São Paulo, Brazil.
Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
出版信息
Arch Dis Child Fetal Neonatal Ed. 2018 Jan;103(1):F49-F55. doi: 10.1136/archdischild-2016-312360. Epub 2017 Jun 29.
OBJECTIVE
To verify whether the use of the T-piece resuscitator compared with the self-inflating bag in preterm infants ventilated at birth modifies survival to hospital discharge without major morbidities.
DESIGN
Pragmatic prospective cohort study.
SETTING
20 Brazilian university hospitals of Brazilian Network on Neonatal Research. Patients were 1962 inborn infants in 2014-2015 ventilated at birth with 23-33' weeks gestation and birth weight 400-1499 g without malformations. Patients transferred until the 27th day after birth were excluded.
INTERVENTIONS
Positive pressure ventilation at birth with T-piece resuscitator or self-inflating bag without positive end expiratory pressure valve. Intervention with ventilation followed the Brazilian Society of Pediatrics guidelines. The choice of the equipment was at the neonatologist's discretion in each delivery. The main outcome measures were survival to hospital discharge without bronchopulmonary dysplasia, severe peri-intraventricular haemorrhage and periventricular leucomalacia. Logistic regression adjusted for confounding variables was applied for main outcome.
RESULTS
1456 (74%) were only ventilated with T-piece resuscitator and 506 (26%) with the self-inflating bag. The characteristics of those ventilated with T-Piece resuscitator versus self-inflating bag were birth weight 969 ± 277 vs 941 ± 279 g, gestational age 28.2±2.5 vs 27.8±2.7 weeks and survival to hospital discharge without major morbidities 47% vs 35%. Logistic regression adjusted for maternal characteristics, obstetric and neonatal morbidities showed that the T-piece resuscitator increased the chance of survival to hospital discharge without major morbidities (OR=1.38; 95% CI 1.06 to 1.80; Hosmer-Lemeshow goodness of fit: 0.695).
CONCLUSION
This study is the first that highlights the effectiveness of T-piece resuscitator ventilation in improving relevant outcomes in preterm neonates.
目的
验证在出生时接受通气的早产儿中，使用T组合复苏器与自动充气式气囊相比，是否能改善无重大疾病存活至出院的情况。
设计
实用前瞻性队列研究。
地点
巴西新生儿研究网络的20家巴西大学医院。研究对象为2014 - 2015年出生的1962例早产儿，出生时接受通气，孕周23 - 33周，出生体重400 - 1499克，无畸形。排除出生后27天内转诊的患者。
干预措施
出生时使用T组合复苏器或不带呼气末正压阀的自动充气式气囊进行正压通气。通气干预遵循巴西儿科学会指南。每次分娩时设备的选择由新生儿科医生自行决定。主要结局指标为无支气管肺发育不良、重度脑室内出血和脑室周围白质软化存活至出院。对主要结局应用经混杂变量调整的逻辑回归分析。
结果
1456例（74%）仅使用T组合复苏器通气，506例（26%）使用自动充气式气囊通气。使用T组合复苏器通气与使用自动充气式气囊通气的患儿特征如下：出生体重分别为969±277克和941±279克，孕周分别为28.2±2.5周和27.8±2.7周，无重大疾病存活至出院的比例分别为47%和35%。经产妇特征、产科和新生儿疾病调整的逻辑回归分析显示，T组合复苏器增加了无重大疾病存活至出院的机会（比值比=1.38；95%置信区间1.06至1.80；Hosmer-Lemeshow拟合优度：0.695）。
结论
本研究首次强调了T组合复苏器通气在改善早产儿相关结局方面的有效性。
Zotero 插件