早產兒執行持續性肺擴張術（sustained inflation）改善呼吸之成效

出生後需正壓通氣（positive pressure ventilation, PPV）維持生命之早產兒，可在產房一出生時，藉由T型手動通氣裝置（T piece），利用面罩（face mask）或氣管內管（endotracheal tube,ET）執行持續性肺擴張術（sustained inflation）；延長吸氣時間可促進排除肺部羊水，使通氣均勻分布，加速建立功能性肺餘容積（functional residual capacity, FRC），減少出生後的肺塌陷損傷、改善氧合作用，文獻證實和使用間歇正壓通氣（intermittent positive pressure ventilation, IPPV）相比，雖未能顯著降低支氣管肺發育不全（bronchopulmonary dysplasia, BPD）發生率和死亡率，但可顯著降低出生後72小時內正壓通氣需求（relative risk, RR 0.87（0.77 to 0.97）），減少正壓通氣使用時間，潛在風險氣胸發生率亦無統計上之顯著差異（relative risk, RR 1.4（0.76 to 2.61））。而小於27週出生之早產兒，因各器官極度不成熟，出生後需進行新生兒復甦術之比例大幅增加，故目前不建議於產房立即執行持續性肺擴張術，避免因心搏過緩而增加死亡率。

關鍵字

持續性肺擴張術； T型手動通氣裝置（Neopuff^(TM)）；肺擴張術

並列摘要

The literature reviews of this article depict that sustained inflation by T piece manual ventilation device via mask or endotracheal tube for the first breath of preterm neonates at birth can accelerate early establishment of functional residual capacity, achieve uniform lung aeration, reduce damage of lung collapse, improve oxygenation, and reduce the need for mechanical ventilation at 72 hours. However, the incidence of bronchopulmonary dysplasia or mortality was not reduced. In addition, excessive inflation may carry a risk of pneumothorax. Nevertheless, current studies indicate that there was no significant difference in the incidence of pneumothorax between infants with sustained inflation and intermittent positive pressure ventilation (relative risk, RR=1.4(0.76 to 2.61)). Overall, sustained inflation can shorten the duration of positive pressure ventilation (relative risk, RR=0.87(0.77 to 0.97)). However, it may increase the risk of mortality and is not recommended for routine use among neonates with gestational age of less than 27 weeks since they always require resuscitation in the delivery room.

並列關鍵字

sustained inflation ； T piece manual ventilation device(Neopuff^(TM)) ； lung inflation

國際替代計量

早產兒執行持續性肺擴張術（sustained inflation）改善呼吸之成效

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