Resuscitation by Intraosseous Infusion in Newborn.
Resuscitation by Intraosseous Infusion in Newborn.
复制标题
新生儿骨内输注复苏。
DOI：
10.1016/s0377-1237(06)80078-x
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发表时间：
2006
影响因子：
--
通讯作者：
Arvind Gupta
中科院分区：
文献类型：
--
作者：
R. Singh Tomar;Arvind Gupta
当周围静脉导管不能放置在5岁以下的危重患儿中时，骨内导管很容易实现。它自1943年以来一直用于复苏[4]，直到最近才被推荐用于新生儿和早产儿的复苏[3]。由于新生儿的骨髓血管丰富，需要给予复苏药物、血液制品晶体和血管加压剂，长骨的髓腔作为不可塌陷的静脉，从此处快速吸收进入循环。骨髓穿刺的血液也可以送去进行初步的实验室调查和交叉配血。骨内线放置的首选部位是胫骨近端内侧板，胫骨粗隆远端0.5-1.0 cm。在骨折、覆盖血管损伤、骨生成障碍、骨硬化症或在同一骨中重复放置线的情况下，不能放置。如果该技术在无菌条件下进行，大多数研究中的并发症发生率低于2%，包括骨髓炎、皮肤感染、皮肤坏死、皮下脓肿、脂肪栓塞、骨折、筋膜室综合征或营养血管孔渗漏[5]。该技术简单，但应采取预防措施，以防止骨骺板损伤，使用适当尺寸和类型的针，理想的是骨内针（图2）或Jamshidi针进行骨髓抽吸。然而，在不可用的情况下，可以组装带有静脉插管管心针的18号一次性针头，并在外周设置中使用[6]。骨内途径必须保持为暂时性血管通路，并尽快更换为静脉管路，最好在24小时内[7]。在骨内输注期间，必须通过X线摄影和每小时测量腿围来监测患者，以确定管路是否仍在原位。由于建立紧急血管通路的速度和容易性，骨内途径具有挽救生命的能力，可作为新生儿复苏期间的替代途径[8]。
DiscussionIntraosseous line is easily achieved when peripheral intravenous lines cannot be placed in critically ill children less than five years of age. It has been in use for resuscitation since 1943 [4] and only recently has been recommended for resuscitations in neonates and preterms [3]. Due to the highly vascular marrow of the neonate, administration of resuscitative drugs, blood products crystalloids and vasopressors is done and the medullary cavity of the long bones serves as a non-collapsible vein from where rapid absorption takes place into the circulation. Blood from marrow aspiration can also be sent for initial laboratory investigation and cross matching. The preferred site of intraosseous line placement is the medial plate of proximal tibia, 0.5-1.0 cm distal to the tibial tuberosity. It cannot be placed in cases of fractured bones, overlying vascular injuries, osteogenesis imperfecta, osteopetrosis or repeated placement of lines in the same bone. If the technique is performed with careful asepsis, the complication rate in most studies is less than 2% and include osteomyelitis, skin infection, skin necrosis, subcutaneous abscess, fat embolism, fractures, compartment syndrome or leakage through the foramina of the nutrient vessels [5]. The technique is easy, but precaution should be taken to prevent damage to the epiphyseal plate with proper size and type of needle, which is ideally an intraosseous needle (Fig 2) or a Jamshidi needle for bone marrow aspiration. However, in case of non-availability, an 18 gauge disposable needle with an intravenous cannula stylet can be assembled and used in a peripheral setup [6]. The intraosseous route must remain a transitory vascular access and be replaced with intravenous line as soon as possible, preferably within 24 hours [7]. During intraosseous infusion, patients have to be monitored with radiography and hourly measurement of leg circumference to determine whether the line is still in place. Intraosseous route has life saving abilities due to speed and ease of establishing emergency vascular access, as an alternate route during neonatal resuscitation [8].