- 期刊
早產兒呼吸窘迫症候群之肺保護通氣策略
The strategy of lung protection in preterm neonates with mechanical ventilation
摘要
根據2003〜2007年美國國家兒童健康與人類發展中心的新生兒研究統計中，出生小於28週的早產兒發生呼吸窘迫症候群（respiratory distress syndrome, RDS）比率高達93%，佔所有早產兒死亡率10〜15%，RDS早產兒接受非侵入式呼吸器（non-invasive ventilation; NIV）、鼻腔持續性正壓呼吸器（nasal continuous positive airway pressure, NCPAP）、鼻腔間斷正壓式呼吸器（nasal intermittent positive airway pressure, NIPPV）以及高流量鼻套管（high flow nasal cannula, HFNC）等方式來輔助呼吸。致病原因為肺泡內肺表面張力素（surfactant）缺乏有關，導致肺順應性降低、增加肺血管阻力、嚴重會合併持續性肺高血壓或氣胸。因此，更需要啟動早產兒「肺部保護通氣策略」（lung-protective ventilatory strategies, LPVS），可包括:使用容積保證換氣、經氣管插管給肺表面張力素後拔管策略、肺泡回復術、容許性高碳酸血症、非傳統的高頻換氣等，以避免容積性損傷（volutrauma）、肺塌陷損傷（atelectrauma）及氧氣中毒等所造成的呼吸器引發肺損傷之合併症產生。近期也發現出生體重低於1500公克的早產兒存活機率有增加的趨勢，因此早產兒的呼吸照護更受到重視，本文綜整相關文獻資料，以提供在新生兒加護病房中，對早產兒呼吸照護與管理方式的參考。
並列摘要
According to neonatal research statistics from the national institute of child health and human development from 2003 to 2007 in united states, the incidence of respiratory distress syndrome (RDS) estimates 93% in preterm neonates less than 28 weeks of gestation. RDS accounted for 10-15% of mortality in preterm neonates. Preterm neonates with RDS are often treated with non-invasive ventilation, nasal continuous positive airway pressure, nasal intermittent positive airway pressure or high flow nasal cannula. The development of RDS is associated with deficiency of surfactant which can result in decreased lung compliance and increased vascular resistance. Sometimes, it can lead to pulmonary hypertension or pneumothorax as well. Hence, it is important to use lung-protective ventilatory strategies (LPVS) in preterm neonates to prevent ventilator associated lung injuries. LPVS include volume guarantee, INSURE(intubation-surfactant-extubation) for administering exogenous surfactant, lung recruitment, permissive hypercapnia and high frequency ventilation. LPVS can reduce volutrauma, atelectrauma and oxygen toxicity; as a result, it is able to prevent lung injuries and complications caused by mechanical ventilators. Recently, with the increasing survival rate in very low birth weight infants (＜ 1500 gm), the issue of respiratory care for preterm neonates is becoming a hot topic. This article aims to provide comprehensive review for respiratory care and management of preterm neonates in the neonatal intensive care unit.