- 期刊
Non-Hyperventilation Respiratory Therapy of Persistent Pulmonary Hypertension of the Newborn
新生兒持續性肺高血壓症之非過度換氣式輔助呼吸療法
摘要
新生兒持續性肺高血壓的治療，在新生兒加護醫療中相當具有挑戰性，平均的死亡率高達40%。辅助呼吸治疗法在此症之治疗中扮演主要的角色，但是其使用的方法也頗有爭議性。輔助呼吸的治療方法包括過度換氣療法(Hyperventilation therapy)，保守性非過度換氣療法(Conservative nonhyperventilation therapy)，高頻式輔助呼吸療法(High-frequency ventilation therapy)。其中過度換氣療法是近十年來最常使用的方式，但是它造成的并發症包括氣胸，新生兒慢性肺部疾病，神經及聽力系統的後遺症引起近年來的關切及爭論。本院從1990年7月至1993年4月以保守性非過度換氣輔助呼吸療法14例新生兒持續性肺高血壓症。我們的治療目標是維持動脈血酸鹸值介7.40至7.50，動脈血氧分壓介於60至90毫米汞柱，動脈血二氧化碳分壓介於30至50毫米汞柱，盡量維持最高呼吸速率每分鍾勿超過60次，最高吸氣壓勿超過35厘米水柱。經治療後有三例死亡存活率為79%，呼吸器平均使用6.8±2.9天。其中四例發生肺氣漏現象(29%)，包括三例肺間質氣腫，一例氣胸，但均未變成新生兒慢性肺部追蹤，有一例發生神經系統之後遺症。新生兒肺高血壓症使用保守性非過度換氣療法來治療，不失為較無侵襲性且費用較不昂貴的方式，值得考慮采用。
關鍵字
新生兒持續性肺高血壓並列摘要
Persistent pulmonary hypertension of the newborn (PPHN) is one of the most challenging situations in the neonatal intensive care nursery and it is associated with a high mortality rate. Hyperventilation therapy has been recommended as the primary ventilator management during recent decades. The associations of pulmonary barotrauma, chronic lung disease and hearing impairment raised the questions of significant pulmonary and neurological complications with this therapeutic modality. From July 1990 to April 1993, 14 cases of neonatal persistent pulmonary hypertension were treated with non- hyperventilation respiratory therapy at the Chang Gung Memorial Hospital. The goals of this therapy were to attain a pH level between 7.40 and 7.50, a Pa02 level between 60 and 90 mmHg and a PaCO2 level between 30 and 50 mmHg. High peak inflating pressure (＞35 cmH2O) and high ventilator rates (＞60/mm) were avoided. The average duration on a ventilator was 6.8±2.9 days. Four patients had pulmonary barotrauma (29%); three of which were pulmonary interstitial emphysema and one pneumothorax. Three patients died (21%). Only one patient had neurological sequelae. No one had developed chronic lung disease. The non-hyperventilation approach for PPHN may be considered as an alternative ventilator management before starting a more aggressive hyperventilation therapy.
延伸閱讀
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