- 期刊
一例重度胎便吸入新生兒之呼吸治療經驗
An Meconium Aspiration Neonatal Intensive Respiratory Care Experience
摘要
胎便吸入綜合症（Meconium aspiration syndrome，MAS）是一個威脅新生兒生命的疾病。嚴重的胎便吸入後會引起急性氣道阻塞、肺炎、肺動脈高壓及表面活性物質缺乏等。臨床主要表現為新生兒呼吸窘迫，其中難治性缺氧、高碳酸血症、酸中毒最為明顯。故胎便吸入患兒氣道處理尤其重要。儘管胎便吸入已是很常見疾病，但在處理上仍有爭議。在有胎便污染羊水的新生兒，一般做法皆在生產時和出生後，進行氣道抽吸，但結果研究顯示，兩種方法均是無效的。目前只推薦在出生後，沒有活力的新生兒，才需要進行氣管插管下的抽吸，對嚴重胎便吸入患兒，常常需要進行機械通氣。高頻通氣（high-frequency oscillatory ventilation，HFV）、吸入性一氧化氮（inhaled nitric oxide；iNO）治療、表面活性物質的使用，甚至體外循環（extracorporeal membrane oxygenation，ECMO）的應用，在拯救新生兒生命時，也常常起了很重要的作用。此報告為一個案分析，探討重症胎便吸入綜合症的新生兒呼吸治療策略。
並列摘要
Meconium aspiration syndrome (MAS) is a life threatening disease of neonate. Severe meconium aspiration will result in acute airway obstruction, pneumonia, pulmonary hypertension and lack of surfactant. Clinical manifestations include neonatal respiratory distress with prominent intractable hypoxemia, hypercapnia and respiratory acidosis. Thus, the management of MAS is crucial. Although MAS is common nowadays, there are controversies on its management. Routine suction should be given when menocium-stained amniotic fluid (MSAF) is noted during labor and at post-partum, but statistics proved both methods fruitless. Current recommendation of suction of tracheal secretions via tracheal intubation was strictly indicated in neonates with poor activity, and mechanical ventilation is required in neonates with severe meconium aspiration. Application of high-frequency oscillatory ventilation (HFOV), inhaled nitric oxide (iNO), surfactant or extracorporeal membrane oxygenation (ECMO) plays a crucial role in these neonates. We, hereby, present a case of successful mechanical ventilation support in severe meconium aspiration induced respiratory distress syndrome of neonate.