新生儿无创辅助呼吸支持介绍

随着新生儿微创辅助通气时代的到来及“开肺策略”的提出，新生儿的无创通气技术理念在世界范围内的NICU得到普及。该文复习了近年来新生儿无创通气技术的有关文献并作简要综述。持续气道正压通气（CPAP）主要原理为在呼气末予以压力支持的一种通气模式，又称之为持续扩张压或呼气末正压通气，经过世界范围内多年的临床实践，CPAP已被证实是一种有效的对患有呼吸系统疾病的新生儿实施呼吸支持的辅助通气模式。由于CPAP价格相对便宜，且易于在临床应用，因此更适合于在发展中国家推广。CPAP辅助通气，除可显著地改善患儿机体的氧合外，对有不同程度气道阻塞的患儿，它可以减轻气道塌陷，因此有助于减少患儿呼吸暂停的发生。文献研究表明，对于32周以下的早产儿，早期应用CPAP可减少患儿气管插管机械通气的机率。该文将试图介绍几种不同的CPAP应用装置和几种不同的CPAP应用方法。虽然对于早期应用CPAP是否能够降低新生儿死亡率及患病率目前尚不十分清楚，但临床实践已经表明，与有创通气比较，CPAP对患儿的损伤小，是一种较为舒适的通气模式，早期应用CPAP还可减少肺泡表面活性物质的使用频率。另外，该文还介绍CPAP的应用指征、优点及其局限性，CPAP的衍生模式如经鼻间歇正压辅助通气以及infant flow CPAP装置等。

Noninvasive respiratory support in neonates: A brief review

In the era of gentle ventilation and open lung strategy noninvasive ventilatory support in neonates has gained momentum and its use in nurseries around the world is also increased.This paper reviews various modalities of non-invasive respiratory support in some details and its relevance in the recent evidence based use.Continuous positive airway pressure(CPAP) is a mode of ventilatory assistance in which positive pressure is delivered to the airway throughout the respiratory cycle.It is also referred to as continuous distending pressure(CDP) or positive end expiratory pressure(PEEP) when applied through a ventilator along with intermittent mandatory ventilation(IMV).It has been proven over the years to be an effective mode of ventilatory support and as such has gained widespread use in the management of a variety of neonatal respiratory diseases.It is relatively cheap and easy to apply and certainly feasible for routine use in underdeveloped world.Besides improving oxygenation CPAP often functions as an airway stabilizer of the trachea thus helping to decrease the frequency of neonatal apneas,particularly the obstructive variety.There is good to fair quality supportive evidence from several studies that the use of primary CPAP can reduce the need for intubation and mechanical ventilation in infants less than 32 weeks gestation.In this review,we will attempt to describe different delivery devices and pressure generating systems and discuss different ways in which CPAP can be applied.Although it is unclear that primary use of CPAP can reduce overall neonatal mortality and morbidity it is becoming increasingly clear that early CPAP use is less invasive,baby friendly and decreases the need and frequency of the use of surfactants.Besides,clinical indications for CPAP,its advantages and limitations will also be explored.CPAP adjuncts such as nasal intermittent positive pressure ventilation(NIPPV) and infant flow driver will also be discussed.