本综述全面研究了无创通气(NIV)策略在管理新生儿呼吸衰竭方面的最新进展,指出呼吸衰竭是早产儿发病和死亡的主要原因。当前的NIV技术,包括持续气道正压通气(CPAP)、鼻间歇正压通气(NIPPV)和高频振荡通气(NHFOV),在减少有创机械通气(IMV...本综述全面研究了无创通气(NIV)策略在管理新生儿呼吸衰竭方面的最新进展,指出呼吸衰竭是早产儿发病和死亡的主要原因。当前的NIV技术,包括持续气道正压通气(CPAP)、鼻间歇正压通气(NIPPV)和高频振荡通气(NHFOV),在减少有创机械通气(IMV)需求方面显示出显著的有效性。此外,最新的神经调节通气辅助(NAVA)和高流量鼻导管(HFNC)技术,以及联合NIV策略和新兴技术,进一步提高了呼吸支持效果。这些策略在临床实践中有效减少了支气管肺发育不良(BPD)的发病率,提高了新生儿的存活率,并改善了长期呼吸和神经发育结果。然而,NIV技术仍面临设备相关并发症、失败的预测因素以及大量培训的挑战。未来的研究方向应包括个性化医疗方法、新技术的开发和全球合作,以优化NIV策略并改善新生儿护理结果。This review comprehensively examines recent advances in noninvasive ventilation (NIV) strategies in the management of neonatal respiratory failure, indicating that respiratory failure is a leading cause of morbidity and mortality in preterm infants. Current NIV technologies, including continuous positive airway pressure (CPAP), nasal intermittent positive pressure ventilation (NIPPV), and high- frequency oscillatory ventilation (NHFOV), have shown significant effectiveness in reducing the need for invasive mechanical ventilation (IMV) sex. In addition, the latest neuroregulated ventilatory assist (NAVA) and high-flow nasal cannula (HFNC) technologies, as well as combined NIV strategies and emerging technologies, further improve respiratory support. These strategies have been effective in clinical practice in reducing the incidence of bronchopulmonary dysplasia (BPD), increasing neonatal survival, and improving long-term respiratory and neurodevelopmental outcomes. However, NIV technology still faces challenges with device-related complications, predictors of failure, and extensive training. Future research directions should include personalized medical approaches, the development of new technologies, and global collaborations to optimize NIV strategies and improve neonatal care outcomes.展开更多
目的探讨应用强迫振荡电抗(Xrs)评估COPD患者的呼气流速受限(EFL)的程度和持续气道正压(CPAP)水平的合理性。方法纳入8例稳定期COPD并Ⅱ型呼吸衰竭患者,取坐位经鼻罩CPAP通气,压力水平分别设为4、8和12 cm H2O。通过振荡发生器向呼吸管...目的探讨应用强迫振荡电抗(Xrs)评估COPD患者的呼气流速受限(EFL)的程度和持续气道正压(CPAP)水平的合理性。方法纳入8例稳定期COPD并Ⅱ型呼吸衰竭患者,取坐位经鼻罩CPAP通气,压力水平分别设为4、8和12 cm H2O。通过振荡发生器向呼吸管道内施加频率为5 Hz、振幅为2 cm H2O的强迫振荡,测量鼻腔压力和流量,采用频谱分析技术计算各呼吸周期的呼气与吸气相电抗之差(ΔXrs)并求各压力水平下的均值;经鼻放置食管测压囊管同步检测食管压力,计算跨气道压,分析各呼吸周期的跨气道压与流量的关系,将呼吸周期划分为EFL呼吸周期和非EFL呼吸周期。试验前8例患者各采集一套自然呼吸时(CPAP=0 cm H2O)的食管压力和流量信号,分析各呼吸周期的EFL情况作为基线水平。比较各CPAP水平下ΔXrs值与EFL呼吸周期数的相互关系,计算检测EFL呼吸周期敏感性和特异性均最高的ΔXrs阈值,计算可消除绝大部分呼吸周期气流受限的CPAP水平。结果①CPAP水平增高,ΔXrs值降低,与CPAP为4、8和12 cm H2O对应的ΔXrs的均值分别为2.67、1.62和1.31 cm H2O.s-1.L-1(CPAP为0 cm H2O时未计算ΔXrs值),其中CPAP从4 cm H2O提高至8 cm H2O时,ΔXrs下降的幅度有统计学意义(Z=-2.68,P=0.01)。②CPAP通气使显示为EFL的呼吸周期数显著减少,CPAP从0 cm H2O提高至4、8和12 cm H2O时,EFL呼吸周期数占全部呼吸周期数的百分比从29.8%分别减少至9.9%、8.1%和4.4%(2=15.6,P=0.01)。③EFL呼吸周期的ΔXrs值显著大于非EFL呼吸周期,分别为(5.95±2.53)和(-0.05±0.62)cm H2O.s-1.L-1(t=11.5,P<0.01)。ΔXrs为1.83 cm H2O.s-1.L-1是区分呼吸周期有或无EFL的阈值,敏感性和特异性分别为94%和97%。结论5 Hz强迫振荡测定的ΔXrs反映了气流受限的程度,在COPD患者无创通气时,逐步调节CPAP水平使ΔXrs值等于或低于1.83 cmH2O.s-1.L-1能消除绝大部分呼吸周期的EFL。展开更多
文摘本综述全面研究了无创通气(NIV)策略在管理新生儿呼吸衰竭方面的最新进展,指出呼吸衰竭是早产儿发病和死亡的主要原因。当前的NIV技术,包括持续气道正压通气(CPAP)、鼻间歇正压通气(NIPPV)和高频振荡通气(NHFOV),在减少有创机械通气(IMV)需求方面显示出显著的有效性。此外,最新的神经调节通气辅助(NAVA)和高流量鼻导管(HFNC)技术,以及联合NIV策略和新兴技术,进一步提高了呼吸支持效果。这些策略在临床实践中有效减少了支气管肺发育不良(BPD)的发病率,提高了新生儿的存活率,并改善了长期呼吸和神经发育结果。然而,NIV技术仍面临设备相关并发症、失败的预测因素以及大量培训的挑战。未来的研究方向应包括个性化医疗方法、新技术的开发和全球合作,以优化NIV策略并改善新生儿护理结果。This review comprehensively examines recent advances in noninvasive ventilation (NIV) strategies in the management of neonatal respiratory failure, indicating that respiratory failure is a leading cause of morbidity and mortality in preterm infants. Current NIV technologies, including continuous positive airway pressure (CPAP), nasal intermittent positive pressure ventilation (NIPPV), and high- frequency oscillatory ventilation (NHFOV), have shown significant effectiveness in reducing the need for invasive mechanical ventilation (IMV) sex. In addition, the latest neuroregulated ventilatory assist (NAVA) and high-flow nasal cannula (HFNC) technologies, as well as combined NIV strategies and emerging technologies, further improve respiratory support. These strategies have been effective in clinical practice in reducing the incidence of bronchopulmonary dysplasia (BPD), increasing neonatal survival, and improving long-term respiratory and neurodevelopmental outcomes. However, NIV technology still faces challenges with device-related complications, predictors of failure, and extensive training. Future research directions should include personalized medical approaches, the development of new technologies, and global collaborations to optimize NIV strategies and improve neonatal care outcomes.
文摘目的探讨应用强迫振荡电抗(Xrs)评估COPD患者的呼气流速受限(EFL)的程度和持续气道正压(CPAP)水平的合理性。方法纳入8例稳定期COPD并Ⅱ型呼吸衰竭患者,取坐位经鼻罩CPAP通气,压力水平分别设为4、8和12 cm H2O。通过振荡发生器向呼吸管道内施加频率为5 Hz、振幅为2 cm H2O的强迫振荡,测量鼻腔压力和流量,采用频谱分析技术计算各呼吸周期的呼气与吸气相电抗之差(ΔXrs)并求各压力水平下的均值;经鼻放置食管测压囊管同步检测食管压力,计算跨气道压,分析各呼吸周期的跨气道压与流量的关系,将呼吸周期划分为EFL呼吸周期和非EFL呼吸周期。试验前8例患者各采集一套自然呼吸时(CPAP=0 cm H2O)的食管压力和流量信号,分析各呼吸周期的EFL情况作为基线水平。比较各CPAP水平下ΔXrs值与EFL呼吸周期数的相互关系,计算检测EFL呼吸周期敏感性和特异性均最高的ΔXrs阈值,计算可消除绝大部分呼吸周期气流受限的CPAP水平。结果①CPAP水平增高,ΔXrs值降低,与CPAP为4、8和12 cm H2O对应的ΔXrs的均值分别为2.67、1.62和1.31 cm H2O.s-1.L-1(CPAP为0 cm H2O时未计算ΔXrs值),其中CPAP从4 cm H2O提高至8 cm H2O时,ΔXrs下降的幅度有统计学意义(Z=-2.68,P=0.01)。②CPAP通气使显示为EFL的呼吸周期数显著减少,CPAP从0 cm H2O提高至4、8和12 cm H2O时,EFL呼吸周期数占全部呼吸周期数的百分比从29.8%分别减少至9.9%、8.1%和4.4%(2=15.6,P=0.01)。③EFL呼吸周期的ΔXrs值显著大于非EFL呼吸周期,分别为(5.95±2.53)和(-0.05±0.62)cm H2O.s-1.L-1(t=11.5,P<0.01)。ΔXrs为1.83 cm H2O.s-1.L-1是区分呼吸周期有或无EFL的阈值,敏感性和特异性分别为94%和97%。结论5 Hz强迫振荡测定的ΔXrs反映了气流受限的程度,在COPD患者无创通气时,逐步调节CPAP水平使ΔXrs值等于或低于1.83 cmH2O.s-1.L-1能消除绝大部分呼吸周期的EFL。
