The Ritchie Centre, Hudson Institute of Medical Research.
Department of Obstetrics and Gynaecology.
Curr Opin Pediatr. 2018 Apr;30(2):187-191. doi: 10.1097/MOP.0000000000000590.
As the infant's physiology changes dramatically after birth, modern neonatal resuscitation approaches should detect and be modified in response to these changes. This review describes the changes in respiratory physiology at birth and highlights approaches that can assist these changes.
To better target assistance given to infants at birth, the changes in lung physiology have been classified into three phases. The first phase involves lung aeration. As little or no gas exchange can occur, assistance should focus on airway liquid clearance. During the second phase, as airway liquid resides in lung tissue, assistance should focus on minimizing the complications associated with lung edema. The third phase occurs whenever the liquid is cleared from the tissue and respiratory mechanics stabilize. Although more traditional approaches are most effective during this phase, this is not the case for the first two phases. Furthermore, the glottis actively adducts during apnea in newborns and so noninvasive respiratory support requires the infant to be breathing so that the glottis will open.
The respiratory support provided to infants at birth should match the infant's changing physiology during transition, which requires a more sophisticated approach and equipment than current recommendations.
由于婴儿出生后生理变化巨大，现代新生儿复苏方法应该能够检测到这些变化并进行相应的调整。本文描述了出生时呼吸生理的变化，并强调了有助于这些变化的方法。
为了更好地针对出生时的婴儿提供帮助，肺生理的变化已被分为三个阶段。第一阶段涉及肺充气。由于几乎没有气体交换发生，因此辅助应侧重于清除气道液体。在第二阶段，由于气道液体仍存在于肺组织中，辅助应侧重于最大限度地减少与肺水肿相关的并发症。第三阶段发生在液体从组织中清除并且呼吸力学稳定时。尽管在这个阶段，更传统的方法最有效，但前两个阶段并非如此。此外，新生儿在呼吸暂停期间声门积极靠拢，因此，非侵入性呼吸支持需要婴儿呼吸，以便声门打开。
出生时为婴儿提供的呼吸支持应与过渡期间婴儿不断变化的生理相匹配，这需要比当前建议更复杂的方法和设备。
