Is premedication for intubation of preterm infants the right choice?
Is premedication for intubation of preterm infants the right choice?
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早产儿插管术前用药是正确的选择吗？
DOI：
10.1016/j.jpeds.2011.07.039
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Kingma,PaulS
中科院分区：
文献类型：
--
作者：
Kingma,PaulS
在过去的20年里，新生儿插管前预给药的问题一直是儿科学中的热门话题，儿科医生对这一问题的看法正在逐渐改变。1992年对美国新生儿重症监护病房（NICU）的一项调查发现，只有3%的新生儿在插管前常规使用镇静剂，97%的新生儿从未或很少使用肌肉松弛剂。[1]相比之下，2006年进行的一项类似调查发现，44%的新生儿重症监护病房常规使用术前用药，25%的新生儿重症监护病房常规使用肌肉松弛剂。[2]尽管术前用药的使用正在增加，美国儿科学会最近也建议非紧急新生儿插管时使用术前用药，但它仍然不是许多新生儿重症监护病房的标准护理。3，4此外，许多产科医生在早产儿插管期间犹豫是否使用术前用药。这种犹豫的原因可能包括担心对婴儿的血流动力学状态或神经发育产生不良影响，认为插管缺乏改善的益处，以及对最佳药物方案缺乏共识。并且肌肉松弛剂减弱了颅内压的升高并减少了成功插管所需的尝试次数和时间。5-18然而，这些研究中很少有包括早产儿的，而且大多数包括早产儿的研究都没有专门检查术前用药对这些婴儿的影响。因此，早产儿人群术前用药的获益和风险以及用于术前用药的最佳药物方案仍不确定。
The question of premedicating neonates before intubation has been actively debated in neonatology over the past 20 years, and neonatologists’ views on this matter are gradually changing. A 1992 survey of neonatal intensive care units (NICU) in the US found that only 3% routinely used sedatives before intubation and 97% never or rarely used a muscle relaxant. 1 In contrast, a similar survey conducted in 2006 found that 44% of NICUs routinely used premedication and 25% routinely used muscle relaxants. 2 Although the use of premedication is on the rise, and the American Academy of Pediatrics recently recommended premedication for nonemergent neonatal intubation, it still is not the standard of care in many NICUs. 3, 4 In addition, many neonatologists hesitate to use premedication during the intubation of preterm infants. Reasons for this hesitation may include fear of adverse effects on the infant’s hemodynamic status or neurodevelopment, perceived lack of benefit in improving the intubation, and lack of consensus regarding the optimal drug regimen.Several previous studies examining the use of premedication in term infants have demonstrated that anticholinergics attenuate bradycardia, analgesics prevent hypertension, and muscle relaxants attenuate increased intracranial pressure and decrease the number of attempts and time required for successful intubation. 5–18 Few of these studies included preterm infants, however, and most of the studies that did include preterm infants did not specifically examine the effects of premedication on these infants. Thus, the benefits and risks of premedication in the preterm population, as well as the optimal drug regimen to use for premedication, remain uncertain.
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