羊水胎粪污染新生儿分娩

海涛妻

      

Number 689, March 2017

      

2017年3月。689号文件

      

Committee on Obstetric Practice

      

产科实践委员会
This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice in collaboration with committee member Michael D. Moxley, MD.

      

这个委员会意见是由ACOG和委员会成员MD共同制定的。

      

This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.

      

这个文件反映了截至日期前临床的变化和科学的进步，以后还会变化。这些信息不应该被解释为被遵循的专属的治疗或程序。

      Delivery of a Newborn With Meconium-Stained Amniotic Fluid      羊水胎粪污染的新生儿的分娩      ABSTRACT:In 2006, the American Academy of Pediatrics and the American Heart       Association published the 2005 guidelines on neonatal （新生儿） resuscitation. 摘要：在2006年，美国儿科学会和美国心脏学会发布了2005新生儿复苏指南      Before the 2005 guidelines, management of a newborn with meconium-stained       amniotic fluid （羊水胎粪污染）      在2005指南之前，对于羊水胎粪污染的新生儿的管理      included suctioning of the oropharynx and nasopharynx on the perineum after the delivery of the head but before the delivery of the shoulders.       包括：在胎头娩出之后胎肩娩出之前吸引口咽和鼻咽。（即后文的产时吸引）      The 2005 guidelines did not support this practice because routine intrapartum suctioning does not prevent or alter the course of meconium aspiration syndrome in vigorous （ 有活力的）newborns.      2005指南不支持这一做法（在胎头娩出之后胎肩娩出之前吸引口咽和鼻咽。      ），因为常规的产时吸引不能阻止或改变有活力的新生儿胎粪吸入综合症的进程       However, the 2005 guidelines did support intubation of the trachea（气管插管） and suctioning of meconium or other aspirated material from beneath the glottis in nonvigorous newborns.        然而，2005指南支持对无活力的新生儿行气管插管吸引胎粪或其他声门下吸入的物质。      In 2015, the guidelines were updated. Routine intubation and tracheal suctioning are no longer required.       2015年，指南更新。不再要求常规的气管插管和气管内吸引。      If the infant is vigorous with good respiratory effort and muscle tone, the infant may stay with the mother to receive the initial steps of newborn care.       如果新生儿有活力，呼吸运动好，肌张力好，新生儿应与母亲在一起接受初级的新生儿护理。（）      If the infant born through meconium-stained amniotic fluid （羊水胎粪污染）presents with poor muscle tone and inadequate breathing efforts, the initial steps of resuscitation should be completed under the radiant warmer.       如果新生儿羊水胎粪，显示出肌张力差和呼吸力度不足，初步的复苏应当在辐温台下进行。      Appropriate intervention to support ventilation and oxygenation should be initiated as indicated for each infant.       对每一个婴儿实施恰当的干预来支持通气和氧和。      Infants with meconium-stained amniotic fluid should no longer routinely receive intrapartum suctioning, whether they are vigorous or not.      新生儿羊水胎粪污染无论有无活力不应该常规的接受产时吸引。       In addition, meconium-stained amniotic fluid is a condition that requires the notification and availability of an appropriately credentialed team with full resuscitation skills, including endotracheal intubation. 除此之外，羊水胎粪污染的情况需要一个可信任的团队，这个团队要掌握全面的复苏技能，包括气管插管，      Resuscitation should follow the same principles for infants with meconium-stained fluid as for those with clear fluid.       对于羊水胎粪污染的新生儿的复苏应遵循和那些羊水清亮的新生儿一样的原则。                  Recommendations      建议      

The American College of Obstetricians and Gynecologists makes the following recommendations:

      

ACOG做了如下建议：

      

      

·         Infants with meconium-stained amniotic fluid, regardless of whether they are vigorous or not, should no longer routinely receive intrapartum suctioning. However, meconium-stained amniotic fluid is a condition that requires the notification and availability of an appropriately credentialed team with full resuscitation skills, including endotracheal intubation.

      

羊水胎粪污染的新生儿，无论有无活力，不再常规进行产时吸引。然而，羊水胎粪污染的情况，需要一个团队，这个团队要能掌握全部的复苏技能，包括气管插管。

      

·         Resuscitation should follow the same principles for infants with meconium-stained fluid as for those with clear fluid.

      

对于羊水胎粪污染的新生儿的复苏，要遵循和羊水清的新生儿一样的复苏原则。

      

In 2006, the American Academy of Pediatrics and the American Heart Association published the 2005 guidelines on neonatal resuscitation (1).

      

在2006年，美国科学会和心脏学会发布了2005新生儿复苏指南。

      

The most significant effect of these guidelines on obstetric practice related to the management of delivery of a newborn with meconium-stained amniotic fluid.

      

关于产科实践，指南中最重要的是对于羊水胎粪污染的新生儿的娩出管理。

      

Before the 2005 guidelines, management of a newborn with meconium-stained amniotic fluid included suctioning of the oropharynx and nasopharynx on the perineum after the delivery of the head but before the delivery of the shoulders (intrapartum suctioning).

      

在2005指南之前，对于胎儿羊水粪染的管理包括在胎头娩出后，胎肩娩出前吸引口咽和鼻咽。（产时吸引）

      

The 2005 guidelines did not support this practice because routine intrapartum suctioning does not prevent or alter the course of meconium aspiration syndrome in vigorous newborns (1).

      

  2005指南不再支持这一做法，因为对有活力的新生儿常规的产时吸引不会阻止或改变胎粪吸入综合症的进展。

      

However, the 2005 guidelines did support intubation of the trachea and suctioning of meconium or other aspirated material from beneath the glottis in nonvigorous newborns (1).

      

然而，2005指南支持对无活力的新生儿行气管插管吸引胎粪或其他声门下吸入物。

      

      

      

In 2015, the guidelines were updated to reflect new evidence in the management of nonvigorous newborns with  meconium-stained fluid.

      

在2015年，指南更新，根据最新的证据关于羊水胎粪污染的无活力的新生儿的管理。

      

Routine intubation and tracheal suctioning are no longer required.

      

不再要求常规的气管插管和气管内吸引

      

If the infant is vigorous with good respiratory effort and muscle tone, the infant may stay with the mother to receive the initial steps of newborn care.

      

如果新生儿有活力，呼吸有力，肌张力好，新生儿应和母亲在一起接受初级的新生儿护理。

      

Gentle clearing of meconium from the mouth and nose with a bulb syringe may be done if necessary.

      

必要时用吸球温和的清理口腔和鼻内的胎粪。

      

If the infant born through meconium-stained amniotic fluid presents with poor muscle tone and inadequate breathing efforts, the initial steps of resuscitation should be completed under the radiant warmer.

      

如果新生儿羊水胎粪污染，肌张力差，呼吸力量不足，应在辐温台下进行初级的复苏。

      

Appropriate intervention to support ventilation and oxygenation should be initiated as indicated for each infant and, if the airway is obstructed, this may include intubation and suction.

      

对每一个新生儿应进行恰当的干预来支持通气和氧和，如果气道梗阻，应进行气管插管和吸引。

      

The new recommendation to no longer routinely suction nonvigorous infants arose from an emphasis on prevention of harm (ie, delays in providing bagmask ventilation and potential consequences of unnecessary interventions) instead of the unknown benefit of the intervention of routine tracheal intubation and suctioning.

      

最新的建议不再常规对无活力新生儿进行吸引，源于强调预防伤害而不是常规气管插管和吸引等干预带来的未知的益处（比如，延迟面罩通气和不必要的干预措施的潜在后果）。

      

The Committee on Obstetric Practice agrees with the recommendation of the American Academy of Pediatrics and the American Heart Association that 产科实践委员会同意美国心脏病协会的建议，

      

      

      

infants with meconium-stained amniotic fluid, regardless of whether they are vigorous or not, should no longer routinely receive intrapartum suctioning.

      

羊水粪染的新生儿，不论他们有无活力，不应常规接受产时吸引。

      

In addition, meconium-stained amniotic fluid is a condition that requires the notification and availability of an appropriately credentialed team (Neonatal Advanced Life Support) with full resuscitation skills, including endotracheal intubation (2).

      

除此之外，羊水胎粪污染这一情况，需要一个团队（新生儿高级生命支持），这个团队要掌握全部的复苏技能，包括气管插管。

      

Resuscitation should follow the same principles for infants with meconium-stained fluid as for those with clear fluid.

      

羊水胎粪污染和羊水清的新生儿应遵循同样的复苏原则。

      References      参考文献      

1.      American Heart Association, American Academy of Pediatrics. 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: neonatal resuscitation guidelines. Pediatrics 2006;117:e1029–38. [PubMed] [Full Text] ⇦

      

2.      Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al. Part 13: neonatal resuscitation: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics 2015;136(suppl 2):S196–218. ⇦