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題名 | Nasal Continuous Positive Airway Pressure Following Surfactant Replacement for the Treatment of Neonatal Respiratory Distress Syndrome=投予肺表面素後以經鼻持續性正壓治療新生兒呼吸窘迫症候群 |
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作 者 | 蘇百弘; 田村正德; 鴨下重彥; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷期 | 35:4 民83.07-08 |
頁次 | 頁280-287 |
分類號 | 417.517 |
關鍵詞 | 呼吸窘迫症候群; 肺表面素; 經鼻持續性正壓; 人工呼吸器; Respiratory distress syndrome; Surfactant; Nasal continuous posiotive airway pressure; Ventilator; |
語文 | 英文(English) |
中文摘要 | 重症新生兒呼吸窘迫症候群(respiratory distress syndrome,RDS)的治療,目前是以人工呼吸器換氣療法加上肺表面素(surfactant)補充療法爲治療的趨勢。本研究的目的是在評估投予肺表面素補充療法後,用經鼻持續性正壓來代替人工呼吸器治療的可行性。由於本研究爲一先驅性試驗,爲了避免極小早産兒可能發生的種種併發症,我們選擇體重1500g以上患有症呼吸窘迫症候群的15個早間兒做爲研究對象。重症新生兒呼吸窘迫症候群的診斷基準爲:1)在使用經鼻持續性正壓療法後仍然有明顯的陷凹呼吸,2)必需投予70%以上濃度的氧氣才能維持PaO2>50mmHg。研究個案在符合重症呼吸窘迫症候群的診斷後,即投予肺表面素120mg/kg體重,然後以信封法隨意將患兒分爲兩組,一組使用人工呼吸器療法(7例),即在投予肺表面素後立即裝著呼吸器開始人工換氣。一組使用經鼻持續性正壓療法(8例),即在投予肺表面素後,立即拔去氣管內管重新經鼻持續性正壓裝置。兩組患兒在投予肺表面素後,a/A PO2(動脈血氧分壓/肺胞內氧分壓)立即有明顯改善,且其效果在研究期間的72小時內持續存在。兩組患兒的a/A PO2值的變化在統計學上沒有差異。在PaCO2方面,經鼻持續性正壓比人工呼吸器組有統計學上有意義的高值。人工呼吸器組在投予肺表面素後8小時以內,PaCO2即呈現在意義的下降。而在經鼻持續性正壓組有比較高的PaCO2值,但是仍維持在可接受的正常圍內。經鼻持續性正壓組的患兒,沒有因臨床症狀惡化以致需要再插管施行人工呼吸的症例發生。我們認爲:在某些羅患重症新生兒呼吸窘迫症候群的患兒,比如出生體重在1500g以上的早産兒,在投予肺表面素補充療法後,可以用經鼻持續性正壓來代替人工呼吸器做爲有效的治療方法。 |
英文摘要 | To evaluate whether nasal continuous positive airway pressure (N-CPAP) could be an alternative to ventilator treatment in infants with severe respiratory distress syndrome (RDS) after surfactant treatment, we performed the trial on 15 newborn babies with birth weight ≥ 1500g. All babies were put on N-CPAP as soon as the diagnosis of RDS was established. The N-CPAP system that we used in this study consisted of no ventilator. When FiO2 ≥0.7 was required for maintaining PaO2 > 50 mmHg, surfactant treatment was decided. After the tracheal instillation of surfactant (120 mg/kg body weight), the babies were randomly assigned into 2 groups. In the ventilator group (n=7), the babies were connected to mechanical ventilation following surfactant instillation. In the N-CPAP group (n=8), the babies were extubated immediately after instillation of surfactant and were connected to N-CPAP. There was a marked improvement in the ratio of arterial PO2 to alveolar PO2 (a/A PO2) immediately following surfactant treatment and the effect was sustained during the study period of 72 hours in both groups. No significant differences in a/A PO2 were noted in 2 groups. There was a significantly higher Pa CO2 in the N-CPAP group than in the ventilator group. PaCO2 declined significantly in the ventilator group 8 hours after surfactant treatment. A delayed decline in PaCO2 until 48 hours after suifactant instillation in the N-CPAP group was noted. However, PaCO2 in the N-CPAP group could be maintained in a permissible range between 43.7±4.3 and 51.5±4.0 mmHg during the study period. We concluded that in a certain group of babies with severe RDS, such as premature babies of birth weight more than 1500g, N-CPAP might be an alternative to ventilator treatment immediately following surfactant instillation. |
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