无创高频与加温湿化高流量鼻导管通气在早产儿呼吸窘迫综合征序贯撤机的临床应用

目的:探讨经鼻无创高频振荡通气(noninvasive high frequency oscillatory ventilation,nHFOV)与加温湿化高流量鼻导管通气(heated humidified high flow nasal cannula,HHHFNC)在极低出生体重早产儿呼吸窘迫综合征(respir...     

高频振荡通气治疗新生儿重症呼吸衰竭18例临床观察

新生儿呼吸衰竭是新生儿重症监护病房(NICU)中最常见的疾病之一,高频振荡通气(HFOV)治疗作为一种新的机械通气方法用于治疗常频辅助通气(CMV)失败的新生儿重症呼吸衰竭取得了较好的效果.现就我院18例新生儿呼吸衰竭患儿使用HFOV治疗后,其肺部氧合功能改善情况分析如下.     

无创通气在治疗新生儿呼吸系统疾病中的应用进展

新生儿的机械通气分为有创机械通气及无创机械通气。为了减少有创通气的肺损伤,目前临床越来越多应用无创通气模式。经鼻间歇正压通气(NIPPV)的早期应用已经成为目前很多新生儿重症监护病房(NICU)的主要无创通气模式,同时早期联合选择性应用肺表面活性物质可以减少慢性肺疾患的发生。文章讨论无创呼吸支持模式的使用,包括持续气道正压通气(CPAP);双水平CPAP模式,例如SiPAP及NIPPV;以及处于研究阶段的同步经鼻间歇正压通气、神经调节辅助通气,无创高频振荡通气等无创通气模式的应用现状及前景。     

中国新生儿无创辅助通气研究现状的可视化研究北大核心CSCD

目的展现中国近五年新生儿无创辅助通气领域的研究情况,描绘该领域的研究趋势,提供未来研究的可能方向。方法采用共词分析法,于2015年4月以自由词"新生儿"及"无创通气"在CNKI数据库进行文献检索及筛选,命中文献457篇,通过Excel 2010建立高频关键词共现矩阵,使用Ucinet 6.3绘制可视化网络。结果中国新生儿无创辅助通气支持方式主要使用经鼻持续气道正压通气治疗新生儿呼吸窘迫综合征;经鼻间歇正压通气及双水平正压通气也逐步应用于临床,各种无创辅助通气技术的应用范围在逐步扩大。除新生儿科医师外,护理工作者也对无创辅助通气技术的效果及实施给予了密切关注。结论该研究初步建立了中国新生儿无创辅助通气的可视化网络,反映近年来该研究领域的热点及现状。     

中国新生儿无创辅助通气研究现状的可视化研究

目的展现中国近五年新生儿无创辅助通气领域的研究情况,描绘该领域的研究趋势,提供未来研究的可能方向。方法采用共词分析法,于2015年4月以自由词"新生儿"及"无创通气"在CNKI数据库进行文献检索及筛选,命中文献457篇,通过Excel 2010建立高频关键词共现矩阵,使用Ucinet 6.3绘制可视化网络。结果中国新生儿无创辅助通气支持方式主要使用经鼻持续气道正压通气治疗新生儿呼吸窘迫综合征;经鼻间歇正压通气及双水平正压通气也逐步应用于临床,各种无创辅助通气技术的应用范围在逐步扩大。除新生儿科医师外,护理工作者也对无创辅助通气技术的效果及实施给予了密切关注。结论该研究初步建立了中国新生儿无创辅助通气的可视化网络,反映近年来该研究领域的热点及现状。     

鼻塞式同步间歇指令通气和持续气道正压通气在治疗新生儿肺透明膜病中的疗效分析

目的比较鼻塞式同步间歇指令通气(nSIMV)和鼻塞持续气道正压通气(nCPAP)在新生儿肺透明膜病(HMD)临床应用效果。方法将新生儿重症监护病房收治的肺透明膜病新生儿79例,随机分为nSIMV组和nCPAP组,治疗后对两组新生儿的血气分析结果、无创通气方式失败例数及呼吸暂停发生例数进行统计分析。结果 nSIMV组新生儿治疗后血气分析与nCPAP组相比有明显改善;nSIMV组患儿使用无创通气方式失败例数、发生呼吸暂停例数较nCPAP组少,差异均有统计学意义(P<0.05)。结论以nSIMV治疗HMD比nCPAP更能减少有创机械通气的使用,同时对于早产儿呼吸暂停可能更有效。     

新生儿疾病诊治技术热点的理念更新(下)

高频振荡通气的临床疗效及其安全性由各种原因导致的新生儿呼吸衰竭及严重肺部病变是新生儿死亡的首位原因。用于治疗呼吸衰竭和各种严重肺病变的机械通气技术 ,是挽救这些新生儿的生命抢救技术。近二十多年来 ,机械通气中的高频振荡通气(HFOV)有了快速的发展 ,其临床应用在大多数发达国家已趋于普遍 ,据统计 ,在欧洲80年代末只有十几个新生儿诊疗中心应用HFOV ,而至90年代末则约有近二百个中心应用HFOV。高频振荡通气具有不同于常频通气(CMV)的基本特征 ,特别是与CMV比较具有的吸、呼气均为主动性 ,潮气量近于、甚至小于死腔量 ,以…     

高频振荡通气治疗常频通气失败的新生儿呼吸窘迫综合征的疗效

新生儿呼吸窘迫综合征(NRDS)是引起新生儿呼吸衰竭的重要原因之一,常见于早产儿,病情危重,进展快,是早产儿死亡的主要原因之一。常频机械通气(CMV)使用以来显著地降低了NRDS患儿的病死率,但也存在部分患儿使用CMV治疗失败的情况。高频振荡通气(HFOV)作为一种新的机械通     

新生儿无创神经辅助通气支持的临床应用

神经辅助通气(neurally adjusted ventilatory assist,NAVA)是呼吸的时间和程度都由患者控制的一种呼吸模式,持续监测患儿的呼吸节律,以膈肌电活动信号(electrical activity of diaphragm,Edi)作为辅助通气的信号,使得不考虑漏气时无创辅助通气的同步得以实现.无创NAVA的优势在于改善人机同步,可靠的呼吸监测,自主调节呼吸.理论上,这些优点使无创NAVA成为呼吸衰竭新生儿有效理想的呼吸支持方式.无创NAVA作为一种新兴的呼吸支持模式用于降低新生儿气管插管率,实现早期拔管,可作为一种新型的持续正压通气模式.     

高频通气在重症肺炎治疗中的应用

高频通气是目前小儿呼吸衰竭程序化治疗(ａｌｇｏｒｉｔｈｍｓｏｆｒｅｓｐｉｒａｔｏｒｙｓｕｐｐｏｒｔ)中的重要手段。一般将高频通气分为高频正压、高频喷射、高频射流阻断和高频振荡。文献报道 ,美国三级医院中已有 90 %的新生儿监护病房 (ＮＩＣＵ)和 85%儿童监护病房 (ＰＩＣＵ)应用高频振荡呼吸机。在我国 ,70年代开始将高频通气应用于儿科临床 ,主要以高频喷射呼吸机为主。 90年代以来 ,国外的高频射流阻断和高频振荡呼吸机逐渐引进我国。高频通气亦已成为我国大城市的新生儿和儿童ＩＣＵ抢救严重呼吸衰竭的重要呼吸支持手段。本文…     

Uncertainties about the use of inhaled nitric oxide in preterm infants

Respiratory failure in the premature neonate is frequently complicated by pulmonary hypertension. When conventional therapies including administration of exogenous surfactant, conventional mechanical ventilation or high-frequency oscillatory ventilation using an appropriate high-volume strategy have failed, one should assess the pulmonary circulation status with colour-coded Doppler echocardiography. There is now considerable evidence that the regulation of foetal and postnatal pulmonary circulation occurs via nitric oxide (NO), and that persistent pulmonary hypertension of the neonate may be related to a relative deficiency in NO release. Low-dose (10–20 ppm), short-duration (1–2 d) inhaled NO has generally been shown to improve the oxygenation and relieve pulmonary hypertension in premature neonates with severely hypoxaemic respiratory failure. Whether this therapy (eventually prolonged >1-3 wk?) would improve survival and lessen morbidity (e.g. intracranial haemorrhage and chronic lung disease) remains to be proven by appropriately designed controlled trials. Until these issues can be clarified, NO therapy for premature neonates should be still considered as an experimental drug, and its use restricted to clinical studies.     

Uncertainties about the use of inhaled nitric oxide in preterm infants

Respiratory failure in the premature neonate is frequently complicated by pulmonary hypertension. When conventional therapies including administration of exogenous surfactant, conventional mechanical ventilation or high-frequency oscillatory ventilation using an appropriate high-volume strategy have failed, one should assess the pulmonary circulation status with colour-coded Doppler echocardiography. There is now considerable evidence that the regulation of foetal and postnatal pulmonary circulation occurs via nitric oxide (NO), and that persistent pulmonary hypertension of the neonate may be related to a relative deficiency in NO release. Low-dose (10-20 ppm), short-duration (1-2 d) inhaled NO has generally been shown to improve the oxygenation and relieve pulmonary hypertension in premature neonates with severely hypoxaemic respiratory failure. Whether this therapy (eventually prolonged >1-3 wk?) would improve survival and lessen morbidity (e.g. intracranial haemorrhage and chronic lung disease) remains to be proven by appropriately designed controlled trials. Until these issues can be clarified, NO therapy for premature neonates should be still considered as an experimental drug, and its use restricted to clinical studies.     

1108例新生儿呼吸衰竭的临床流行病学特征

目的 对1 108 例新生儿呼吸衰竭病例的临床流行病学特征进行分析,为提高临床治疗水平和开展多中心临床研究提供参考。方法 采用统一调查表收集1 108 例呼吸衰竭新生儿的临床资料,对原发疾病、临床治疗方法、治疗结局、病死率等流行病学指标进行统计学分析。结果 1 108 例患儿中位胎龄为37+1 周,中位出生体重为2 600 g,入NICU 中位日龄为0.71 d(17 h),男/ 女比例为3.1:1。主要原发疾病为呼吸窘迫综合征(30.51%)、肺部感染/ 败血症(23.55%)和湿肺(13.18%)。治疗中采用经鼻持续气道正压通气(nCPAP)占48.64%,高频振荡通气占12.81%、使用肺表面活性物质占13.45%、NO 吸入治疗占8.66%,病死率达24.19%。结论 呼吸窘迫综合征为新生儿呼吸衰竭的主要原发疾病,使用肺表面活性物质、nCPAP、高频振荡通气、NO 吸入治疗已经成为新生儿呼吸衰竭的主要救治手段,但新生儿呼吸衰竭的病死率仍然较高。     

Haemodynamic features during high-frequency oscillatory ventilation in preterms

Aim: To compare the haemodynamic status during high-frequency oscillatory ventilation and conventional mechanical ventilation in very preterm infants with respiratory distress syndrome. Methods: Thirty-two neonates of less than 30 wk gestation randomly assigned to high-frequency oscillatory ventilation (n = 15) or conventional mechanical ventilation (n = 17) had three echocardiographies and one cerebral Doppler-echography under the same ventilation during the first 48 h of life. Results: Mean airway pressure was 2 cm H[Formula: See Text]O higher in infants ventilated with high-frequency oscillatory ventilation at the different echocardiographies. Comparable right ventricular indexes were observed in the two groups. Reduction of the ductus arteriosus diameter and ductal closure were significant only in neonates ventilated conventionally. Left ventricular performance and left ventricular contractility did not differ between the groups. The high-frequency group had lower end diastolic velocity and a higher resistance index in the anterior cerebral artery.

Conclusion: Compared with conventional mechanical ventilation, high-frequency oscillatory ventilation was achieved without altering cardiac function. However, the inability of the left ventricle to improve its performance in the presence of a significant ductal shunt suggests a narrow range of optimal pressures under this ventilatory mode.     

Pulmonary mechanics in preterm neonates with respiratory failure treated with high-frequency oscillatory ventilation compared with conventional mechanical ventilation

Pulmonary mechanics were measured in 43 preterm neonates (mean +/- SD values of birth weight 1.2 +/- 0.3 kg, gestational age 30 +/- 2 weeks) with respiratory failure who were concurrently randomly assigned to receive conventional mechanical ventilation (n = 22) or high-frequency ventilation (n = 21). The incidence of bronchopulmonary dysplasia was comparable in the two groups (high-frequency ventilation 57%, conventional ventilation 50%). Pulmonary functions were determined at 0.5, 1.0, 2.0, and 4.0 weeks postnatal ages. Data were collected while subjects were in a nonsedated state during spontaneous breathing. These sequential data show similar patterns of change in pulmonary mechanics during high-frequency ventilation and conventional mechanical ventilation irrespective of gestational age, birth weight stratification, or bronchopulmonary dysplasia. There was no significant difference in the pulmonary functions with either mode of ventilation during the acute phase (less than or equal to 4 weeks) of respiratory disease. When evaluated by the clinical diagnosis of bronchopulmonary dysplasia, the pulmonary data suggested a less severe dysfunction in the high-frequency oscillatory ventilation-treated bronchopulmonary dysplasia group compared with the conventional mechanical ventilation-treated group. These results indicate that high-frequency oscillatory ventilation in preterm neonates does not reduce the risk of acute lung injury; however, the magnitude of the pulmonary dysfunction in the first 2 weeks of life merits a reevaluation.     

High-frequency jet ventilation in neonatal pulmonary hypertension

To determine if high-frequency jet ventilation is beneficial in neonates with persistent pulmonary hypertension, we compared the ventilator settings, blood gas concentrations, and outcome of infants who met established criteria for a high predictive mortality. During a six-year period, 14 neonates who had severe respiratory failure and hypoxemia while receiving conventional ventilation were treated with high-frequency jet ventilation. Twenty-three comparable infants meeting the same criteria were treated exclusively with conventional ventilation. After initiation of high-frequency jet ventilation there was a significant reduction in mean airway pressure and partial pressure of arterial carbon dioxide (PaCO2). In contrast, neonates treated exclusively with conventional ventilation continued to have higher airway pressures and PaCO2. However, there was no difference in the alveolar-to-arterial oxygen gradient, air leakage, incidence of bronchopulmonary dysplasia, or duration of assisted ventilation or oxygen supplementation. Furthermore, mortality was comparable in both groups of infants. These preliminary observations suggest that high-frequency jet ventilation can reduce airway pressure and PaCO2 in neonates with persistent pulmonary hypertension but does not appear to improve outcome.     

不同机械通气方式联合肺表面活性物质对新生儿急性肺损伤/急性呼吸窘迫综合征疗效比较

目的 比较高频振荡通气+肺表面活性物质 （HFOV+PS）、常频机械通气+肺表面活性物质 （CMV+PS）、常频机械通气 （CMV）3种治疗方式对新生儿急性肺损伤/急性呼吸窘迫综合征 （ALI/ARDS）的临床疗效。方法 纳入ALI/ARDS新生儿136例 （ALI73例,ARDS63例）,其中HFOV+PS组45例,CMV+PS组53例,CMV组38例,前两组应用肺表面活性物质气管内滴入 （70~100mg/kg）。分别检测机械通气0h、12h、24h、48h、72h的PaO2、PaCO2、PaO2/FiO2、氧合指数 （OI）、呼吸指数 （RI）。结果 机械通气12h、24h、48h时HFOV+PS组的PaO2高于CMV+PS组和CMV组,PaCO2低于CMV+PS组和CMV组 （P < 0.05）;在机械通气12h、24h、48h、72h时HFOV+PS组PaO2/FiO2高于CMV+PS组和CMV组,OI、RI低于CMV+PS组和CMV组 （P < 0.05）;HFOV+PS组机械通气时间、用氧时间均低于CMV+PS组和CMV组 （P < 0.05）;3组气漏、颅内出血发生率及治愈率比较差异无统计学意义。结论 与单纯CMV以及CMV联合PS治疗相比,HFOV联合PS更可改善ALI/ARDS新生儿的肺功能,缩短通气时间及用氧时间,且不增加并发症的发生。     

新生儿高频振荡通气的撤机方式探讨

新生儿呼吸衰竭是新生儿重症监护室常见的危重症,尽管临床医生希望最大限度地利用无创呼吸支持,但有些低出生体重早产儿一开始就需要用到有创呼吸支持。高频振荡通气（HFOV）作为治疗呼吸衰竭的重要呼吸管理技术,它允许用小于或等于解剖死腔的潮气量快速输送进行气体交换,利用持续膨胀压使肺均一扩张,但同时对肺组织的反复牵拉作用较小,对肺部有保护作用,从而受到临床医师的青睐,目前临床应用已较为普遍。但对于HFOV后如何拔管撤机目前仍不统一。该文就HFOV的撤机方式进行综述,以期为临床提供帮助。     

Systemic air embolism in an extremely low birthweight infant treated with high-frequency oscillatory ventilation

An extremely low birthweight infant in whom systemic air embolism occurred during high-frequency oscillatory ventilation is reported. He was delivered at 25 weeks and 6 days gestation weighing 600 g. He was diagnosed as having respiratory distress syndrome and had intermittent mandatory ventilation. At 2 days of age, there was pulmonary hemorrhage and high-frequency oscillatory ventilation was begun. The maximum mean airway pressure during high-frequency oscillatory ventilation was 22 cmH₂O. At 9 days of age, X-ray film revealed air in the intracardiac cavity and major systemic vessels. Systemic air embolism can occur in an extremely low birthweight infant having high-frequency oscillatory ventilation with a mean airway pressure of 22 cmH₂O or higher.     

New developments in neonatal respiratory management

Respiratory distress syndrome (RDS) is the major cause of respiratory failure in preterm infants due to immature lung development and surfactant deficiency. Although the concepts and methods of managing respiratory problems in neonates have changed continuously, determining appropriate respiratory treatment with minimal ventilation-induced lung injury and complications is crucially important. This review summarizes neonatal respiratory therapy's advances and available strategies (i.e., exogenous surfactant therapy, noninvasive ventilation, and different ventilation modes), focusing on RDS management.