切换至 "中华医学电子期刊资源库"

中华妇幼临床医学杂志(电子版) ›› 2023, Vol. 19 ›› Issue (02) : 139 -144. doi: 10.3877/cma.j.issn.1673-5250.2023.02.003

专题论坛

早产儿非心脏手术的麻醉管理
苏永维, 陈果()   
  1. 四川大学华西医院麻醉科,成都 610041
  • 收稿日期:2022-11-22 修回日期:2023-03-21 出版日期:2023-04-01
  • 通信作者: 陈果

Anesthetic management for non-cardiac surgery in preterm infants

Yongwei Su, Guo Cheng()   

  1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2022-11-22 Revised:2023-03-21 Published:2023-04-01
  • Corresponding author: Guo Cheng
  • Supported by:
    Natural Science Foundation by Science & Technology Department of Sichuan Province
引用本文:

苏永维, 陈果. 早产儿非心脏手术的麻醉管理[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(02): 139-144.

Yongwei Su, Guo Cheng. Anesthetic management for non-cardiac surgery in preterm infants[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(02): 139-144.

随着早产儿存活率增长,早产儿相关疾病发病率显著增加,其中多数疾病需外科手术治疗。由于早产儿生理功能尚未发育成熟,手术及麻醉风险均较高,早产儿非心脏手术(NCSP)围术期死亡率及并发症发生率亦均较高,因此早产儿的麻醉管理,对降低其术后相关并发症发生率,促进术后快速康复,降低其围术期死亡率等,发挥着至关重要的作用。笔者拟就NCSP围术期麻醉管理中关于麻醉方式选择,全身麻醉诱导与维持,以及围术期体温、血压、血糖管理的最新研究进展进行阐述,旨在为改善NCSP围术期麻醉管理提供参考。

With the growing birth rate of preterm infants, there is a significant increase in incidence of diseases in preterm infants, most of which require surgical treatment. However, preterm infants experience high risks of surgery and anesthesia due to the immaturity of their organ systems and concurrent disease states. The perioperative mortality and morbidity of non-cardiac surgery in preterm infants (NCSP) reported in the literature are relatively high. Therefore, anesthetic management of NCSP plays a vital role in reducing postoperative complications and perioperative mortality, promoting rapid postoperative recovery. This paper intends to elaborate on the selection of anesthesia methods, general anesthesia induction and maintenance during anesthetic management of NCSP, as well as the latest research progress in perioperative temperature, blood pressure, and blood glucose management. Thus, this review can provide references for improving anesthetic management of NCSP.

[1]
Delnord M, Zeitlin J. Epidemiology of late preterm and early term births:an international perspective[J]. Semin Fetal Neonatal Med, 2019, 24(1): 3-10. DOI: 10.1016/j.siny.2018.09.001.
[2]
Chen C, Zhang JW, Xia HW, et al. Preterm birth in China between 2015 and 2016[J]. Am J Public Health, 2019, 109(11): 1597-1604. DOI: 10.2105/AJPH.2019.305287.
[3]
Cao Y, Jiang S, Sun J, et al. Assessment of neonatal intensive care unit practices, morbidity, and mortality among very preterm infants in China[J]. JAMA Netw Open, 2021, 4(8): e2118904. DOI: 10.1001/jamanetworkopen.2021.18904.
[4]
Zhang J, Sun K, Zhang Y. The rising preterm birth rate in China: a cause for concern[J]. Lancet Glob Health, 2021, 9(9): e1179-e1180. DOI: 10.1016/S2214-109X(21)00337-5.
[5]
Jansen G, Irmscher L, May TW, et al. Incidence, characteristics and risk factors for perioperative cardiac arrest and 30-day-mortality in preterm infants requiring non-cardiac surgery[J]. J Clin Anesth, 2021, 73: 110366. DOI: 10.1016/j.jclinane.2021.110366.
[6]
Disma N, Veyckemans F, Virag K, et al. Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)[J]. Br J Anaesth, 2021, 126(6): 1157-1172. DOI: 10.1016/j.bja.2021.02.016.
[7]
Moser JJ, Archer DP, Walker AM, et al. Association of sedation and anesthesia on cognitive outcomes in very premature infants: a retrospective observational study[J]. Can J Anaesth, 2023, 70(1): 56-68. DOI: 10.1007/s12630-022-02353-7.
[8]
Dohms K, Hein M, Rossaint R, et al. Inguinal hernia repair in preterm neonates: is there evidence that spinal or general anaesthesia is the better option regarding intraoperative and postoperative complications? A systematic review and Meta-analysis[J]. BMJ Open, 2019, 9(10): e028728. DOI: 10.1136/bmjopen-2018-028728.
[9]
Salaün JP, de Queiroz M, Orliaguet G. Development: epidemiology and management of postoperative apnoea in premature and term newborns[J]. Anaesth Crit Care Pain Med, 2020, 39(6): 871-875. DOI: 10.1016/j.accpm.2020.07.013.
[10]
Schroepf S, Mayle PM, Kurz M, et al. Prematurity is a critical risk factor for respiratory failure after early inguinal hernia repair under general anesthesia[J]. Front Pediatr, 2022, 10: 843900. DOI: 10.3389/fped.2022.843900.
[11]
Massoud M, Kühlmann A, van Dijk M, et al. Does the incidence of postoperative complications after inguinal hernia repair justify hospital admission in prematurely and term born infants?[J]. Anesth Analg, 2019, 128(3): 525-532. DOI: 10.1213/ANE.0000000000003386.
[12]
Ozawa Y, Ades A, Foglia EE, et al. Premedication with neuromuscular blockade and sedation during neonatal intubation is associated with fewer adverse events[J]. J Perinatol, 2019, 39(6): 848-856. DOI: 10.1038/s41372-019-0367-0.
[13]
Disma N, Virag K, Riva T, et al. Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study[J]. Br J Anaesth, 2021, 126(6): 1173-1181. DOI: 10.1016/j.bja.2021.02.021.
[14]
Jagannathan N, Asai T. Difficult airway management: children are different from adults, and neonates are different from children![J]. Br J Anaesth, 2021, 126(6): 1086-1088. DOI: 10.1016/j.bja.2021.03.012.
[15]
Yamada NK, McKinlay CJ, Quek BH, et al. Supraglottic airways compared with face masks for neonatal resuscitation: a systematic review[J]. Pediatrics, 2022, 150(3): e2022056568. DOI: 10.1542/peds.2022-056568.
[16]
Zhang Q, Zhao H, Feng Y. Laryngeal mask airway with pressure support ventilation vs. endotracheal tube with pressure controlled ventilation in preterm infants undergoing ROP surgery: a propensity score matching analysis of perioperative complications[J]. J Clin Anesth, 2019, 57: 141-142. DOI: 10.1016/j.jclinane.2019.04.001.
[17]
Subramaniam R. Anaesthetic concerns in preterm and term neonates[J]. Indian J Anaesth, 2019, 63(9): 771-779. DOI: 10.4103/ija.IJA_591_19.
[18]
Tesoro S, Marchesini V, Fratini G, et al. Drugs for anesthesia and analgesia in the preterm infant[J]. Minerva Anestesiol, 2020, 86(7): 742-755. DOI: 10.23736/S0375-9393.20.14073-2.
[19]
Nasr VG, Davis JM. Anesthetic use in newborn infants: the urgent need for rigorous evaluation[J]. Pediatr Res, 2015, 78(1): 2-6. DOI: 10.1038/pr.2015.58.
[20]
Trevisanuto D, Testoni D, de Almeida M. Maintaining normothermia: why and how?[J]. Semin Fetal Neonatal Med, 2018, 23(5): 333-339. DOI: 10.1016/j.siny.2018.03.009.
[21]
Madar J, Roehr CC, Ainsworth S, et al. European Resuscitation Council Guidelines 2021: newborn resuscitation and support of transition of infants at birth[J]. Resuscitation, 2021, 161: 291-326. DOI: 10.1016/j.resuscitation.2021.02.014.
[22]
McCall EM, Alderdice F, Halliday HL, et al. Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants[J]. Cochrane Database Syst Rev, 2018, 2(2): CD004210. DOI: 10.1002/14651858.CD004210.pub5.
[23]
Thewissen L, Naulaers G, Hendrikx D, et al. Cerebral oxygen saturation and autoregulation during hypotension in extremely preterm infants[J]. Pediatr Res, 2021, 90(2): 373-380. DOI: 10.1038/s41390-021-01483-w.
[24]
Ågren J, Segar JL, Söderström F, et al. Fluid management considerations in extremely preterm infants born at 22-24 weeks of gestation[J]. Semin Perinatol, 2022, 46(1): 151541. DOI: 10.1016/j.semperi.2021.151541.
[25]
Sümpelmann R, Becke K, Zander R, et al. Perioperative fluid management in children: can we sum it all up now?[J]. Curr Opin Anaesthesiol, 2019, 32(3): 384-391. DOI: 10.1097/ACO.0000000000000727.
[26]
Blanco CL, Kim J. Neonatal glucose homeostasis[J]. Clin Perinatol, 2022, 49(2): 393-404. DOI: 10.1016/j.clp.2022.02.003.
[27]
Committee on Fetus and Newborn, Adamkin DH. Postnatal glucose homeostasis in late-preterm and term infants[J]. Pediatrics, 2011, 127(3): 575-579. DOI: 10.1542/peds.2010-3851.
[28]
Narvey MR, Marks SD. The screening and management of newborns at risk for low blood glucose[J]. Paediatr Child Health, 2019, 24(8): 536-554. DOI: 10.1093/pch/pxz134.
[29]
Angelis D, Jaleel MA, Brion LP. Hyperglycemia and prematurity: a narrative review[J]. Pediatr Res, 2023: 37120652. DOI: 10.1038/s41390-023-02628-9.
[30]
Kolesky SE, Nyshadham S, Williams HO, et al. Intraoperative dextrose rate during exploratory laparotomies in neonates and the incidence of postoperative hyperglycemia: a retrospective observational study[J]. Paediatr Anaesth, 2021, 31(2): 197-204. DOI: 10.1111/pan.14078.
[1] 董红华, 郭艮春, 江磊, 吴雪飞, 马飞翔, 李海凤. 骨科康复一体化模式在踝关节骨折快速康复中的应用[J]. 中华关节外科杂志(电子版), 2023, 17(06): 802-807.
[2] 付佳, 肖海敏, 武曦, 冯涛, 师帅. 年龄校正查尔森合并症指数对腹腔镜结直肠癌围手术期并发症的预测价值[J]. 中华普通外科学文献(电子版), 2023, 17(05): 336-341.
[3] 夏松, 姚嗣会, 汪勇刚. 经腹腹膜前与疝环充填式疝修补术治疗腹股沟疝的对照研究[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 702-705.
[4] 徐金林, 陈征. 抗菌药物临床应用监测对腹股沟疝修补术预防用药及感染的影响[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 720-723.
[5] 代格格, 杨丽, 胡媛媛, 周文婷. 手术室综合干预在老年腹股沟疝患者中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 759-763.
[6] 王蕾, 王少华, 牛海珍, 尹腾飞. 儿童腹股沟疝围手术期风险预警干预[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 768-772.
[7] 朱青青, 卫贞祺. 腹股沟疝患者围手术期自我能效管理探讨[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 773-777.
[8] 朱迪, 欧阳钒, 杨丹, 华敏, 吴倩. 双轨护理在老年腹股沟疝无张力修补术围手术期的应用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 630-634.
[9] 张汪, 徐淑英, 张爱华, 夏芬荣, 汪露. 手术室体温护理结合细节护理干预在老年腹股沟疝围手术期的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 635-638.
[10] 董玉花, 魏红花, 孔荷香, 周莉, 孙小花. 主动性个性化心理干预在成人腹股沟疝围手术期患者护理中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 652-656.
[11] 蓝冰, 王怀明, 王辉, 马波. 局部晚期结肠癌膀胱浸润的研究进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 505-511.
[12] 中华医学会骨科分会关节学组. 中国髋、膝关节置换日间手术围手术期管理专家共识[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 321-332.
[13] 苏鹏, 吕会来, 温士旺, 黄超, 张缜, 田子强. 全腔镜下食管癌根治术围手术期呼吸系统并发症发生的危险因素分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 294-298.
[14] 王军, 刘鲲鹏, 姚兰, 张华, 魏越, 索利斌, 陈骏, 苗成利, 罗成华. 腹膜后肿瘤切除术中大量输血患者的麻醉管理特点与分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 844-849.
[15] 索利斌, 刘鲲鹏, 姚兰, 张华, 魏越, 王军, 陈骏, 苗成利, 罗成华. 原发性腹膜后副神经节瘤切除术麻醉管理的特点和分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 771-776.
阅读次数
全文


摘要