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題名 | 缺氧缺血腦病變新生兒低溫治療之呼吸照護經驗=Respiratory Care for a Neonatal with Hypoxic Ischemic Encephalopathy from Perinatal Asphyxia Treated with Hypothermia |
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作者 | 張雅雯; 許馨玫; 賴菲菲; 蘇千玲; 葉育雯; 汪性寧; Chang, Ya-wen; Shu, Shin-mei; Lai, Fei-fei; Su, Chien-ling; Yeh, Yu Wung; Wang, Hsing-ning; |
期刊 | 呼吸治療雜誌 |
出版日期 | 20130700 |
卷期 | 12:2 2013.07[民102.07] |
頁次 | 頁123-135 |
分類號 | 415.415 |
語文 | chi |
關鍵詞 | 周產期窒息; 缺氧缺血性腦病變; 低溫治療; Perinatal asphyxia; Hypoxic ischemic encephalopathy; HIE; Therapeutic hypothermia; |
中文摘要 | 新生兒低溫治療可使身體在缺氧的情況下重建氧的供需平衡,可提高存活率,減少神經系統的後遺症。但是治療期間會引起整體免疫力下降,需特別注意維持呼吸道通暢、支氣管衛生及預防呼吸器相關肺炎。另外因凝血機能下降執行胸腔物理治療之胸部扣擊、震盪治療前後,應特別小心預防皮膚瘀青、皮下出血等傾向。低體溫也會抑制胰島素分泌而有血糖異常的情形,血糖太高或太低都會引起代謝性酸中毒而造成呼吸變深、潮氣量變大,應注意吐氣端潮氣量變化,調整呼吸次數,需經常監測動脈血液氣體分析值維持適當的通氣量。避免過度通氣形成腦血管收縮而引起灌流減少及細胞缺氧。以上是針對周產期窒息導致的缺氧缺血性腦病變個案,於低溫治療期中呼吸治療師應執行重點。希望藉由此個案能讓呼吸治療師更了解當病患執行低溫治療時的呼吸照護處置。 |
英文摘要 | Hypothermia therapy in neonates improves oxygen supply and demand under hypoxic conditions. It reduces neurologic sequelae of hypoxemia and increases survival. Throughout the duration of hypothermia therapy, however, the patient's innate immunity may be compromised. Therefore, keeping airway patency and paying special attention to bronchial hygiene can prevent ventilator-associated pneumonia. Hypothermia may also cause coagulopathy. Chest percussion and oscillation as part of chest physiotherapy in the context of coagulopathy may result in excessive ecchymosis or subcutaneous hematoma. Hypothermia suppresses insulin secretion, leading to abnormal glucose metabolism. Extreme fluctuation of blood glucose is associated with metabolic acidosis, which may in turn cause compensatory hyperventilation and increase in tidal volume. The ventilator setting needs to be meticulously adjusted. Frequent arterial blood gas determination helps to maintain adequate ventilation and prevent hyperventilation-induced cerebral vasoconstriction and ischemia. We report the use of hypothermia therapy in a patient with hypoxic ischemic encephalopathy caused by perinatal asphyxia. We hope to demonstrate in particular the aspect of respiratory care in hypothermia therapy and hypoxic ischemic encephalopathy. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。