Doty Morgen S, Chauhan Suneet P, Chang Kate W-C, Al-Hafez Leen, McGovern Connie, Yang Lynda J-S, Blackwell Sean C
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas.
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
AJP Rep. 2020 Jan;10(1):e42-e48. doi: 10.1055/s-0040-1705140. Epub 2020 Mar 4.
The main objective of this article is to determine if persistence of neonatal brachial plexus palsy (NBPP) following shoulder dystocia was associated with maneuvers used or duration of impacted shoulder. Retrospective review of children with NBPP and documented shoulder dystocia. Student -tests and chi-squared tests were used to compare outcomes when shoulder dystocia resolved with > 3 versus ≤ 3 maneuvers or duration > versus ≤ 120 seconds. Relative risk (RR) with 95% confidence intervals (CI) was calculated. Among 46 children with NBPP and shoulder dystocia, incidence of persistence was significantly higher at 2 years of age when > 3 versus ≤ 3 maneuvers were used (100 vs. 62%; RR: 1.6, 95% CI: 1.2-2.2). When resolution of impacted shoulder lasted >120 versus ≤ 120 seconds, NBPP at 2 years was significantly more likely (100 vs. 63%; RR: 1.6, 95% CI: 1.1-2.2). Injury to all five nerves of the brachial plexus was more likely if standard deviation lasted > 120 versus ≤ 120 seconds (RR: 2.2; 95% CI: 1.03-4.6). Though the number of maneuvers used and duration of shoulder dystocia are associated with persistence of NBPP, the retrospective nature of the study of a selective cohort precludes recommendations changing the current management of shoulder dystocia.
本文的主要目的是确定肩难产之后新生儿臂丛神经麻痹（NBPP）的持续存在是否与所采用的手法或嵌顿肩的持续时间有关。
对患有NBPP且有肩难产记录的儿童进行回顾性研究。当肩难产通过超过3次与≤3次手法或持续时间>与≤120秒得以解决时，使用学生t检验和卡方检验来比较结果。计算95%置信区间（CI）的相对风险（RR）。
在46例患有NBPP和肩难产的儿童中，当使用超过3次与≤3次手法时，2岁时麻痹持续的发生率显著更高（100%对62%；RR：1.6，95%CI：1.2 - 2.2）。当嵌顿肩的解决持续时间>120秒与≤120秒时，2岁时发生NBPP的可能性显著更高（100%对63%；RR：1.6，95%CI：1.1 - 2.2）。如果标准差持续时间>120秒与≤120秒，臂丛神经所有五根神经受损的可能性更大（RR：2.2；95%CI：1.03 - 4.6）。
尽管所采用的手法数量和肩难产的持续时间与NBPP的持续存在有关，但对一个选择性队列研究的回顾性性质排除了改变当前肩难产处理方式的建议。
