早产儿玻璃体腔注射后的气道管理与术后呼吸恢复
Airway management and postoperative respiratory recovery after intravitreal injection in preterm infants.
文献信息
| PMID | 42778692 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Ying Chen |
| 作者单位 | Department of Anesthesia, Capital Center for Children's Health, Capital Medical University, Capital Institute of Pediatrics, Beijing, China. |
| 期刊 | Pediatric research |
| SCI 分区 | Q1 |
| IF | 3.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 因早产儿视网膜病变接受玻璃体腔注射雷珠单抗的早产儿易发生围手术期呼吸不稳定。气道策略是否与术后呼吸恢复相关尚不清楚。
方法： 我们开展了一项回顾性单中心队列研究，纳入134例在全身麻醉下接受玻璃体腔注射雷珠单抗的早产儿。患儿采用喉罩气道（LMA，n=83）或气管插管（ETI，n=51）进行管理。主要结局为24小时内呼吸支持升级。主要分析采用逆概率治疗加权。
结果： LMA组有6/83例（7.2%）发生呼吸支持升级，ETI组有20/51例（39.2%）。在加权分析中，LMA使用与较ETI更低的风险相关（RR 0.36，95% CI 0.15-0.88；P=0.026）。在未调整的次要分析中，LMA组更可能在24小时内恢复至基线支持水平（90.4%对66.7%，P=0.012），且更少需要非计划再插管（1.2%对9.8%，P=0.044）。
结论： 在手术室内接受全身麻醉下玻璃体腔注射的特定早产儿中，与ETI相比，LMA使用与更好的早期术后呼吸恢复相关。当LMA置入技术上可行且临床上适当时，这些发现可能适用。
影响： 在手术室内接受全身麻醉下玻璃体腔注射的早产儿中，与气管插管相比，喉罩气道使用与24小时内呼吸支持升级风险更低相关。本研究采用逆概率治疗加权来处理已测量的基线差异，提供了经混杂调整的估计，并将激光光凝的观察结果扩展至更短暂的玻璃体腔注射情境。这些发现具有相关性且可产生假设，当喉罩置入技术上可行且临床上被认为是一种合适的气道选择时，可能为气道装置选择提供信息。有必要开展前瞻性多中心研究。
英文摘要
BACKGROUND: Preterm infants undergoing intravitreal ranibizumab injection for retinopathy of prematurity are vulnerable to perioperative respiratory instability. Whether airway strategy is associated with postoperative respiratory recovery remains unclear.
METHODS: We conducted a retrospective single-center cohort study of 134 preterm infants undergoing intravitreal ranibizumab injection under general anesthesia. Infants were managed with a laryngeal mask airway (LMA, n = 83) or endotracheal intubation (ETI, n = 51). The primary outcome was respiratory support escalation within 24 hours. The primary analysis used inverse probability of treatment weighting.
RESULTS: Respiratory support escalation occurred in 6/83 (7.2%) infants in the LMA group and 20/51 (39.2%) in the ETI group. In the weighted analysis, LMA use was associated with a lower risk than ETI (RR 0.36, 95% CI 0.15-0.88; P = 0.026). In unadjusted secondary analyses, the LMA group was more likely to return to baseline support by 24 hours (90.4% versus 66.7%, P = 0.012) and less likely to require unplanned reintubation (1.2% versus 9.8%, P = 0.044).
CONCLUSION: In selected preterm infants undergoing intravitreal injection under general anesthesia in the operating room, LMA use was associated with better early postoperative respiratory recovery than ETI. The findings may apply when LMA placement is technically feasible and clinically appropriate.
IMPACT: In preterm infants undergoing intravitreal injection under general anesthesia in the operating room, laryngeal mask airway use was associated with a lower risk of respiratory support escalation within 24 hours than endotracheal intubation. Using inverse probability of treatment weighting to address measured baseline differences, this study provides a confounding-adjusted estimate and extends observations from laser photocoagulation to the briefer setting of intravitreal injection. The findings are associative and hypothesis-generating and may inform airway-device selection when laryngeal mask placement is technically feasible and clinically considered an appropriate airway option. Prospective multicenter studies are warranted.