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首页> 外文期刊>Journal of perinatology: Official journal of the California Perinatal Association >Avoiding endotracheal intubation of neonates undergoing laser surgery for retinopathy of prematurity.
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Avoiding endotracheal intubation of neonates undergoing laser surgery for retinopathy of prematurity.

机译：避免对因早产儿视网膜病变进行激光手术的新生儿进行气管插管。

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OBJECTIVE: Respiratory support of neonates during and following laser surgery for retinopathy of prematurity (ROP) is commonly accomplished using endotracheal intubation and mechanical ventilation. However, most patients undergoing ROP surgery have been weaned off mechanical ventilation days or weeks before the surgery. When they are electively re-intubated for ROP surgery, it can be difficult to extubate them postoperatively. One of the three level III neonatal intensive care units (NICUs) in the Intermountain Healthcare system initiated a program of using nasopharyngeal prongs, rather than endotracheal intubation, for respiratory support during ROP surgery. METHODS: We performed an historic cohort analysis of all neonates undergoing ROP surgery during their NICU stay at the three level III NICU's between 1 January 2002 and 31 March 2006. Data collected included birth weight, gestational age at delivery and corrected gestational age at ROP surgery, whether or not they were intubated in the days immediately preceding the ROP surgery, whether or not they were electively intubated for the ROP surgery, the respiratory modality used during and the 3 days following ROP surgery, and all blood gas determinations and respiratory charges during this period. RESULTS: Fifty-four patients underwent ROP surgery during this period. All 23 from NICUs 'A' and 'B' had endotracheal intubation for surgery, while in NICU 'C' 24 were managed using nasopharyngeal prongs. The birth weights of those intubated for surgery (661+/-180 g, mean+/-s.d.) were similar to those not intubated (732+/-180 g). Similarly, the gestational age at birth did not differ between those intubated for surgery (25.2+/-1.3 week) and those not (25.6+/-2.1 week). The day following surgery, 77% (23/30) of those who had been intubated for surgery remained intubated and on mechanical ventilation, whereas only one (4%) of those not intubated for surgery was intubated in the postoperative period (P<0.001). On day 3 following surgery, 50% (15/30) of those intubated for surgery remained intubated and on mechanical ventilation, whereas none of those not intubated for surgery were intubated (P<0.001). Management with nasopharyngeal prongs did not result in higher PCO(2)s, or lower pH values, during or after surgery. Respiratory charges for the 3 days following surgery were 1762+/-678 dollars (mean+/-s.d.)/patient among those intubated versus 357+/-352 dollars/patient for those managed with nasopharyngeal prongs (P<0.001). CONCLUSIONS: Neonates undergoing laser surgery for ROP can often be supported intraoperatively and postoperatively using nasopharyngeal prongs, thus avoiding the need for endotracheal intubation.
机译：目的：早产儿视网膜病变（ROP）激光手术期间和之后的新生儿呼吸支持通常通过气管插管和机械通气来实现。但是，大多数接受ROP手术的患者已在手术前几天或几周断奶。当将他们选择性地再次插管进行ROP手术时，可能很难在术后拔管。 Intermountain Healthcare系统中的三个III级新生儿重症监护病房（NICU）中的一个发起了一项在ROP手术中使用鼻咽管插管而不是气管插管的呼吸支持方案。方法：我们对2002年1月1日至2006年3月31日期间在所有三级NICU进行NICU期间进行ROP手术的所有新生儿进行了历史性队列分析。收集的数据包括出生体重，分娩胎龄和ROP手术矫正胎龄，是否在ROP手术之前的几天内进行了插管，是否为ROP手术选择性地进行了插管，在ROP手术期间和术后3天使用的呼吸方式以及在检查期间的所有血气测定和呼吸道收费这一时期。结果：54名患者在此期间接受了ROP手术。重症监护病房“ A”和“ B”的全部23例均进行了气管插管以进行手术，而重症监护病房“ C”中的24例均使用鼻咽管进行了治疗。接受插管手术者的出生体重（661 +/- 180 g，平均值+/- s.d。）与未插管者的出生体重（732 +/- 180 g）相似。同样，插管手术者（25.2 +/- 1.3周）和非插管者（25.6 +/- 2.1周）在出生时的胎龄无差异。手术后第二天，有77％（23/30）的患者接受了插管手术，并且仍进行了机械通气，而在未接受手术的患者中，只有一个（4％）在术后进行了插管（P <0.001 ）。手术后第3天，接受插管的患者中有50％（15/30）仍插管并接受机械通气，而未插管的患者均未插管（P <0.001）。鼻咽插管的管理在手术期间或之后均未导致较高的PCO（2）s或较低的pH值。术后3天，插管者的呼吸费用为每位患者1762 +/- 678美元（平均+/-标准差），而鼻咽插管者为每位患者357 +/- 352美元（P <0.001）。结论：为鼻腔内手术进行激光手术的新生儿通常可以在术中和术后使用鼻咽管进行支撑，从而避免了气管插管的需要。

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