Postextubation Atelectasis of the Newborn

新生兒氣管內管拔管後的肺部膨脹不全

楊宏義(Horng-Yie Yang) ； 林其和(Chyi-Her Lin) ； 陳森輝(Shen-Hui Chen)

《Acta Paediatrica Sinica》 28卷3期 (1987/06) Pp. 141-147

摘要

為了明瞭氣管內管拔管後，產生肺部膨脹不全的新生兒之特點，以及描述這些膨脹不全的肺部其臨床表現以及最終的命運，本文在2年半的期間內，收集了44個合於研究標準的病例。
44例中，18例(41%)產生氣管內管拔管後的肺部膨脹不全，發生的時間以拔管後1天內居多，肺右上葉為最容易波及位置。比較產生膨脹不全的嬰兒與控制組，顯示前者常由外面醫院轉送而來，剛住院時常有代謝性酸中毒，接受呼吸器治療時有較高的最高肺泡動脈氧分壓差、最高動脈二氧化碳分壓、最大呼吸器設定值（除了呼吸速率以外）、較長的時間使用氣管內管、以及拔管時有較高的實際重碳酸。18例產生肺部膨脹不全的病嬰內，有8例其肺部的問題持續存在並有明顯的肺體積縮小，其餘10例，其膨脹不全的肺部平均約8.6天後再度膨脹。有否以重新插管的方式去處理膨脹不全的肺，通常不會影響肺部將來是否再度膨脹。本篇研究顯示導致氣管內管拔管後產生肺部膨脹不全的因素，第一是肺部疾病的嚴重性本身，第二是呼吸器治療，至於如何對膨脹不全的肺部做最好的治療，則有待將來的研究。

並列摘要

To define the characteristics of infants at great risk for postextubation atelectasis, and to describe the presentation and fate of these collapsed lungs, a total of 44 neonates was selected over a two-and-a-half year period for study.
Eighteen (41%) infants were noted to have postextubation atelectasis. Of these, 14 (77.8%) developed atelectsis within one day after extubation. The right upper lobe was frequently involved. Comparing infants with postextubation atelectasis to controls, the former were more likely to be outborn and acidotic on admission and had higher highest A-aDO2, highest PaCO2, maximum value of respirator settings except for ventilatory rate, and a longer intubation period. At extubation, more metabolic compensation was found in infants with postextubation atelectasis. Of the 18 infants with postextubation atelectasis, in 8 the pulmonary lesions persisted with marked volume loss; in 10 infants, the atelectatic lungs reexpanded after a mean of 8.6 days. Attempts to reexpand the collapsed lungs did not alter their eventual outcome.
Present study demonstrated that the predisposing factors for postextubatisn atelectasis were, primarily, severity of the lung disease, and respirator therapy, secondarily The optimal therapy for pulmonary atelectasis deserves further study.

並列關鍵字

postextubation ； atelectasis ； newborn