Direct Tracheobronchial Suction for Massive Post-Extubation Atelectasis in Premature Infants

直接氣管抽吸法治療早産兒拔管後之肺擴張不全

宋文舉(Wen-Jue Soong) ； 鄭玫枝(Mei-Jy Jeng) ； 黃碧桃(Be-Tau Hwang)

《Acta Paediatrica Sinica》 37卷4期 (1996/08) Pp. 266-271

https://doi.org/10.7097/APS.199608.0266

摘要

本研究爲評估一項應用於新生兒拔管後肺擴張不全的創新治療技術。於新生兒加護中心內，從事爲期四年的前瞻性研究。此項新的治療技術謂之“直接氣管抽吸法”，使用的對象需完全符合下列三條件：1)新的肺擴張不全發生於拔管後的48小時內；2)對傳統的胸部物理治療方法無效，且臨床狀況地在惡化；及3)在X光片上之患側無明顯的“air bronchogram”。直接氣管抽吸法之損傷爲：以咽喉鏡先挑起咽喉直視氣管開口，同時調整擺放頭部位置的幫助下，以一般之抽吸管(6.5Fr)，直接進入左側或右側的支氣管內，再施行抽吸術以清除阻塞物，而使肺部能重新擴張。比較治療臆後的臨床症候、X光片、及血液氣體分析值的變化。
總共在連續的736位拔管後的新生兒中，有145位得到肺擴張不全，發生率爲19.7%；其中有31例(4.2%)的肺擴張不全發生於18位新生兒，合乎條件而進入本研究。除了一位以外，所有嬰兒的體重皆小於1,500公克，平均爲1,043±269公克；在統計學上：很明顯地在體重小於1,500公克的幼兒有較高的拔管後肺擴張不全發生率，及較多地都接受直接氣管抽吸法之治療，16位嬰兒的氣管插管時間都小於7天，平均爲14.1±5.0天；治療後的臨床症候、X光片、及血液氣體分析值亦皆有明顯的改善。結論：直接氣管抽吸法確實可以有效的去除阻塞的分泌物，而使較小早産幼兒之肺擴張不全能重新地恢複。

關鍵字

直接氣管抽吸法 ； 肺擴張不全

並列摘要

A prospective four-year study was done in a neonatal intensive care unit (NICU) to evaluate a technique, called direct tracheobronchial suction (DTBS), for rapidly removal of obstructive secretions from the tracheobronchial tree in newborn infants with massive post-extubation atelectasis (PEA). Selected cases who met the following criteria were enrolled: 1) developing new massive atelectasis within 48 hours after extubation; 2) no response to vigorous chest physiotherapy (CPT) and continuous deterioration; and 3) no air-bronchogram in the atelectatic lung field. DTBS was carried on at bedside by direct insertion a 6.5 Fr suction catheter into tracheobronchial tree and suctioning. Clinical and laboratory assessments were made in each case prior to and at two hours after DTBS for comparison. A total of 145 (19.7%, 145/736)) PEA occurred in a consecutive 736 postextubated newborn infants. Thirty-one atelectasis (4.2%, 31/736) that developed in 18 infants were managed with DTBS. There was a significant higher incidence of PEA developed, as well as a higher ratio of PEA been treated by DTBS, in the group of body weight ＜ 1,500g than the group of ≥1,500 g. All except one infants weighed less than 1,500 g, with a mean of 1,043±269 g. Sixteen infants had been intubated for more than seven days with a mean of 14.1±5.0 days. Nine infants required more than one session of DTBS. DTBS was quite effective in immediate removal of retained secretions and improvement of pulmonary condition. By clinical assessment, respiratory distress improved with increased audible air entry on the affected lung, decreased chest retractions, and a significant fall in respiratory rate and heart rate. Arterial blood gases analysis showed significant improvement of pH, partial pressure of carbon dioxide and oxygenation ratio. By chest radiograph, DTBS resulted partial or nearly complete resolution of the atelectasis in all cases. DTBS procedures were well tolerated by all infants without significant sequelae. Conclusion: This study suggests that DTBS is a simple and effective therapeutic modality to rapidly correct the massive PEA which resist to vigorous CPT in small infants.

並列關鍵字

atelectasis ； post-extubation atelectasis ； tracheobronchial suction ； premature infant