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頁籤選單縮合
題 名 | 兒童急性呼吸衰竭之氧合處理=Management of Oxygenation in Pediatric Acute Respiratory Failure |
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作 者 | 戴任恭; 吳俊仁; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 4:3 2002.07[民91.07] |
頁 次 | 頁177-183 |
分類號 | 417.512 |
關鍵詞 | 急性呼吸衰竭; 保護肺臟策略; 一氧化氮; 表面張力素; 液態呼吸; 體外膜式氧合機; 抗氧化劑; Acute respiratory failure; Protect lung strategy; iNO; Surfactant; Liquid ventilation; Extracorporeal membrane oxygenation; Antioxidant; |
語 文 | 中文(Chinese) |
中文摘要 | 所謂呼吸衰竭,是指二氧化碳動脈分壓(PaCO₂)高於50 mmHg,或是氧動脈分壓(PaCO₂)低於60 mmHg。本文所論述的急性呼吸衰竭,即指多樣性的急性低血氧性呼吸衰竭(AHRF)。它即是急性肺傷害和急性呼吸窘迫症候群(ARDS)的標誌。兒童加護病房中,急性呼吸衰竭仍有相當高的罹患率及死亡率。其死亡原因大部分是敗血症或多重器官衰竭。其支持療法首重處理氧合作用,並避免因治療而發生的肺傷害之副作用。新近發展的治療方法中,只有以設定低潮氣容積(6 mL/kg),限制高原期壓力(30 cmH₂O)的保護肺臟策略,可以降低死亡率。另外,徵募計策、高頻振盪通氣、反比換氣、伏臥姿勢、吸入型一氧化氮、表面張力素、液態呼吸、體外膜式氧合機及抗發炎藥物等治療策略,雖無法証實降低死亡率,卻也發現其可短暫改善氧合作用或降低使用呼吸器日數。 總之,在兒童急性呼吸衰竭死亡率仍居高不下之際,除了改進目前使用的治療策略,仍需等待兒童加護病房整體支持性療法再繼續提昇。 |
英文摘要 | Respiratory failure is defined as the impaired ability of the respiratory system to maintain adequate oxygen and carbon dioxide homeostasis, and the commonly used criteria are a partial pressure of arterial carbon dioxide (PaCO₂) of more than 50 mmHg or partial pressure of arterial oxygen (PaO₂) of less than 60 mmHg in a subject breathing air at sea level. Acute respiratory failure remains a significant cause of morbidity and mortality for children admitted to pediatric intensive care units. Moreover, Acute hypoxemic respiratory failure (AHRF) is most frequently discussed and is the hallmark of acute lung injury and acute respiratory distress syndrome (ARDS). Most new therapeutic interventions for pediatric acute hypoxemic respiratory failure (AHRF) are extrapolated from adult and neonatal studies. After all, their goals are to improve oxygenation and prevent from ventilator-associated lung injury (VALI). Only the lung-protective strategy, specifying a low tidal volume (6 mL/kg) and a plateau pressure limit (30 cmH₂O), can reduce the mortality of acute respiratory failure. Although other maneuvers, such as recruitment maneuver, high frequency oscillatory ventilation, reverse ratio ventilation strategy, prone position, inhaled nitric oxide, surfactant, liquid ventilation, extracorporeal membrane oxygenation and antioxidant, could not reduce the mortality, most of them are reported to transiently improve the oxygenation or shorten the duration of ventilatory support. At present, we need to further investigate the new treatments of oxygenation and improve the general supportive treatment for pediatric acute respiratory failure, while its mortality is still not improved. |
本系統中英文摘要資訊取自各篇刊載內容。