Kim E H
Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA 95128.
J Perinatol. 1989 Mar;9(1):72-6.
Sixty newborn infants who had been mechanically ventilated through 3.0- or 3.5-mm endotracheal tubes were studied to examine the necessity of a preextubation trial of continuous positive airway pressure (CPAP). Thirty randomly assigned study infants were directly extubated from intermittent mandatory ventilation rates of six per minute; 30 randomly assigned control infants were extubated after a six-hour trial of continuous positive airway pressure of 3 cm H2O. Changes in respiratory rate, in PCO2, and in PO2/FIO2 were similar. All 30 study infants tolerated direct extubation without significant apnea or respiratory acidosis. Two study and eight control infants developed apnea during six hours after intermittent mandatory ventilation was discontinued (chi 2 = 4.3, P less than .05). Five control and no study infants had apneic episodes greater than or equal to 0.5 per hour (chi 2 = 5.5, P less than .02). The results of this study suggest that newborn infants may tolerate direct extubation from low intermittent mandatory ventilation rates without a preextubation trial of CPAP. A preextubation trial of CPAP appears to be unnecessary and may cause more frequent apnea in newborn infants if used for more than several hours.
对60例通过3.0或3.5毫米气管内导管进行机械通气的新生儿进行了研究，以检验拔管前进行持续气道正压通气（CPAP）试验的必要性。30例随机分配的研究婴儿在每分钟6次的间歇强制通气率下直接拔管；30例随机分配的对照婴儿在3厘米水柱的持续气道正压通气试验6小时后拔管。呼吸频率、PCO2和PO2/FIO2的变化相似。所有30例研究婴儿耐受直接拔管，无明显呼吸暂停或呼吸性酸中毒。2例研究婴儿和8例对照婴儿在间歇强制通气停止后的6小时内出现呼吸暂停（χ2 = 4.3，P < 0.05）。5例对照婴儿和无研究婴儿每小时呼吸暂停发作次数≥0.5次（χ2 = 5.5，P < 0.02）。本研究结果表明，新生儿可能耐受从低间歇强制通气率直接拔管，而无需进行拔管前CPAP试验。拔管前CPAP试验似乎没有必要，如果使用超过数小时，可能会导致新生儿更频繁地出现呼吸暂停。
