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標題: | 於加護病房執行持續性肺擴張術對早產兒呼吸相關 問題之效果 – 臨床隨機分派試驗 Respiratory effects of sustained lung inflation for preterm neonates at Intensive Care Unit – A randomized controlled trial |
作者: | Li-Ting Lu 呂俐葶 |
指導教授: | 蘇玫尹(Mei-Yin Su),翁逸豪(Yi-Hao Weng) |
關鍵字: | 持續性肺擴張術,早產兒,T 型手動通氣裝置,機械通氣,支氣管肺發育不全, sustained lung inflation,preterm neonate,T piece manual ventilation device,mechanical ventilation,BPD, |
出版年 : | 2021 |
學位: | 碩士 |
摘要: | 背景與目的:持續性肺擴張術(sustained lung inflation)可加速建立功能性肺餘容積(functional residual capacity),早產兒於產房執行持續性肺擴張術能顯著降低正壓機械通氣使用時間,但對於是否可以進一步降低支氣管肺發育不全發生率則未有一致性之發現,而且可能增加極度早產兒於出生後48小時內之死亡率。因此,本研究為首例將持續性肺擴張術應用於加護病房,探討於加護病房執行持續性肺擴張術對早產兒呼吸相關問題的效果。 方法:為單一中心新生兒加護病房的前瞻性臨床隨機分派試驗。收案條件為懷孕27~36週出生因呼吸窘迫需要使用正壓機械通氣之早產兒,排除氣胸、嚴重先天構造異常(包含嚴重的先天性心臟病)或出生超過1天轉診之早產兒,並隨機分派為控制組與試驗組,兩組均接受標準正壓機械通氣治療,試驗組另接受持續性肺擴張術之處置,在出生3天內實施每天1次持續15秒、吸氣壓力20 cmH2O及吐氣末正壓5 cmH2O之持續性肺擴張術。 結果:本研究於收案期間共收錄45名早產兒,包括控制組21位,試驗組24位。兩組的出生平均週數、平均體重、阿普伽新生兒出生後1分鐘及5分鐘平均分數等出生後基本資料無顯著差異。相較於控制組,試驗組能顯著降低正壓機械通氣使用天數(11.9 ± 8.2 vs. 19.6 ± 16.1, p = 0.044)。其他結果如支氣管肺發育不全、氣胸及住院期間死亡率,兩組沒有顯著差異;試驗組無案例發生支氣管肺發育不全,而控制組有2例(9.5%)發生重度支氣管肺發育不全之疾病,p值 = 0.212。 結論:由加護病房呼吸治療師專責執行持續性肺擴張術是一個安全且具效益之呼吸策略;本研究發現大於或等於27週出生之早產兒執行持續性肺擴張術可明顯縮短正壓機械通氣使用天數,沒有氣胸及住院期間死亡之潛在合併症發生;在樣本數較少的情況下,觀察到支氣管發育不全的發生率呈現略微降低之趨勢,但未達顯著降低之效益。 Background and Objective:Sustained lung inflation (SLI) is proposed to accelerate the establishment of functional residual capacity. SLI conducted in the delivery room has significantly reduced the duration of mechanical ventilation in preterm neonates. However, its effect to decrease bronchopulmonary dysplasia (BPD) is controversial. In contrast, it may increase the mortality of preterm infants within 48 hours of life. Our study is the first survey to investigate the impact of SLI conducted in the neonatal intensive care unit (NICU). Methods:This prospective study was a randomized controlled trail conducted in a NICU. Neonates with a gestational age (GA) of 27~36 weeks requiring positive pressure ventilation after birth were eligible for enrollment. Those with pneumothorax, major congenital anomaly (including severe congenital heart disease), and admitted to the NICU after 24 hours of life were excluded. Enrolled neonates were randomly assigned into the control group or the experimental group. Both groups received mechanical ventilation. The experimental group of SLI with maximum pressure of 20 cmH2O for 15 s followed by continuous positive airway pressure (CPAP) of 5 cmH2O once per day for first 3 consecutive days. Results:A total of 45 neonates were enrolled into this study, including 24 in the experimental group and 21 in the control group. The results showed no significant difference in the birth condition between the experimental and control groups, including GA, birth weight, Apgar score at 1 min and 5 min. The duration of mechanical ventilation was significantly shorter in the experimental group (11.9 ± 8.2 d) than the control group (19.6 ± 16.1 d) (p=0.044). There was no significant difference in the other outcomes, such as pneumothorax, death before discharge, and BPD; there were 2 and 0 cases of BPD in the control and experimental groups, respectively (p=0.212). Conclusions:The results demonstrate that SLI conducted by an experienced respiratory therapist in the NICU is safe with benefit effect. Our findings suggest that SLI is suitable for preterm neonates born more than or equal to 27 weeks gestational age, which will reduce the duration of mechanical ventilation significantly without potential complications, such as pneumothorax and death. Because the sample size of this study was small, we could only observe a trend in the decrease of BPD without a statistical significance. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/15339 |
DOI: | 10.6342/NTU202100412 |
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顯示於系所單位: | 運動設施與健康管理碩士學位學程 |
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