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对呼吸护理方案的评估,包括在早产婴儿中少入侵地表面活性剂的使用
Christina S Chan1, Melody Chiu1, Swathi Ariyapadi1
1University of Texas Southwestern Medical Center, Dallas, TX, USA.
Pediatric research
|December 14, 2023
概括
较少侵入性表面活性剂 (LISA) 成功减少了早产婴儿的机械通风 (MV) 需求. 较低的妊娠年龄和更高的氧气需求预测了LISA失败,指导了未来的干预措施.
科学领域:
- 新生儿科学 新生儿科学
- 儿科呼吸系统医学 儿科呼吸系统医学
- 关键的护理关键的护理
背景情况:
- 在2018年10月,为妊娠年龄 (GA) ≤29周的婴儿实施了一项包含少侵入性表面活性剂 (LISA) 的呼吸护理协议.
- 本研究评估了LISA对这种脆弱人群的呼吸支持需求和结果的影响.
研究的目的:
- 为了比较婴儿管理的持续正气道压力 (CPAP) 与没有LISA的结果.
- 确定LISA故障的预测因素,定义为生命72小时内需要机械通风 (MV) (HOL).
主要方法:
- 一项回顾性研究分析了2018年10月至2021年12月期间接受CPAP治疗的婴儿.
- 在接受LISA治疗的婴儿和仅使用CPAP治疗的婴儿之间,对母亲和新生儿的变量进行了比较.
- 经历LISA失败的婴儿与经历LISA成功的婴儿进行了比较.
主要成果:
- 在接受CPAP治疗的249名婴儿中,有143人接受了LISA,其中108人 (75.5%) 取得了LISA成功 (LS),35人 (24.5%) 经历了LISA失败 (LF).
- 与LS婴儿相比,LF婴儿的GA,出生体重显著降低,并且需要更高的FiO2和CPAP水平.
- 怀孕年龄≤25周和FIO2≥0.3一个小时后LISA是LISA失败的强有力的预测因素.
结论:
- 在接受CPAP治疗的婴儿中,超过80%的婴儿在72小时内避免了MV,这证明了非侵入性策略的有效性.
- 早期识别LISA失败预测因素,如低GA和高氧需求,可以引导及时干预,以尽量减少早产婴儿的MV使用.
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