低體重新生兒麻醉

ANESTHESIA FOR THE LOW BODY WEIGHT NEONATES

彭翠瑾(Jsui-Jin Peng) ； 黃潔文(Kit-Man Wong) ； 譚培炯(Peter P. C. Tan)

《Acta Anaesthesiologica Sinica》 28卷3期 (1990/09) Pp. 329-336

摘要

本文收集從民國74年元月起，到民國78年12月底止，過去5年內在長庚紀念醫院台北開刀房，58個接受手術而且當日體重在2500公克以下的新生兒病例，並追跡存活者的出院預後至民國79年4月。在這些病例中，依體位分等（physical status）ASAII 31例（53%），ASAIII 26例（45%），ASAIV 1例（2%）。體重小於1500公克者9例（16%）,1501-2000公克者17例（29%），2000公克以上者32例（55%）。年齡以任娠週數（gestational age）表示，則足月滿38週者26例（45%）；未足月者在成熟邊緣（borderline prematurity）14例（24%），中度未成熟（moderate prematurity）16例（28%），非常不成熟（extreme prematurity）21例（3%）。58個病例均採用插管全身麻醉，開刀以接受腹部手術居多（32例），手術結束都送到小兒科加護病房。死亡25例，死亡率42%，其中4例在術後24小時內死亡。在此次研究中發現，手術過程中體溫的變化和新生兒的死亡有其統計上的意義（p＜0.05），而33例存活者，尚未發現產生任何特殊的併發症。

關鍵字

Gestational age ； Preterm ； Prematurity

並列摘要

58 newborns weighting under 2500 gm were collected, who received surgery in the past five years (1985-1989) in Chang Gung Memorial Hospital , Taipei, and followed up the survivors until April 1990.We classified these 58 cases by physicalstatus that 31 cases (53%) were in ASA II , 26(45%) in ASA III, 1 (2%) in ASA IV; by bodyweight that 9 cases (16%) were under 1500 gm, 17 (29%) between 1501 and 2000 gm, 32 (55 %)over 2000 gm; by gestational age that 26 cases(45%) were in term pregnancy, 14 (24%) in borderline prematurity, 16 (28%) in moderate prematurity, 2 (3%) in extreme prematurity. All these 58 cases were under endotracheal general anesthesia, the majority of surgery (32 cases) were abdominal procedures. They were all sent to pediatric intensive care unit after operation. The mortality rate was 42% (25 cases), 4 cases of those were dead within the post-operative 24 hours. In this study, the change of temperature during operative procedures was significantly correlative to the neonatal mortality (p＜0.005).