羊水胎粪污染新生儿复苏的前世今生：过去60年中美两国的演变史

The evolution of approach in the resuscitation of neonates born with meconium-stained amniotic fluid: a tale of two countries, China and U.S.A., in the past 60 years

摘要:

出生于羊水胎粪污染的新生儿可发生新生儿胎粪吸入综合征、持续性肺动脉高压等并发症，甚至死亡。在过去的几十年里，羊水胎粪污染新生儿复苏已发生了几次重要的变革。最初，对于羊水胎粪污染新生儿，通常在其出生后立即采用喉镜直视下吸引声门下胎粪。自2015年起，美国儿科学会新生儿复苏指南不再推荐对羊水胎粪污染无活力新生儿“常规”给予气管插管吸引胎粪，但建议立即给予气囊面罩正压通气复苏。然而，最新版2021年中国新生儿复苏指南仍保留对无活力新生儿进行胎粪吸引的建议。该文旨在探讨过去60年中美两国新生儿复苏指南在羊水胎粪污染新生儿复苏方法中的差异及其原因。

Abstract:

Neonates born through meconium-stained amniotic fluid (MSAF) may develop complications including meconium aspiration syndrome, persistent pulmonary hypertension of newborn and death. The approach to the resuscitation of these neonates has significantly evolved for the past few decades. Initially, under direct visualization technique, neonates with MSAF were commonly suctioned below the vocal cords soon after delivery. Since 2015, Neonatal Resuscitation Program (NRP^?) of the American Academy of Pediatrics has recommended against "routine" endotracheal suctioning of non-vigorous neonates with MSAF but favored immediate resuscitation with positive pressure ventilation via face-mask bagging. However, the China neonatal resuscitation 2021 guidelines continue to recommend routine endotracheal suctioning of non-vigorous neonates born with MSAF at birth. This review article discusses the differences and the rationales in the approach in the resuscitation of neonates with MSAF between Chinese and American NRP^? guidelines over the past 60 years.