DOI: https://doi.org/10.24061/2413-4260.V.1.15.2015.20

Фізіологія дихання і респіраторна підтримка у новонароджених

V. I. Snisar, D. N. Surkov, A. A. Obolonskij

Анотація


Стаття присвячена фізіології дихання у новонароджених, проведення штучної вентиляції легенів і змінам з боку дихальної системи, викликаним анестезією і операцією.  Розглядаються оптимальн іметоди респіраторної підтримки у недоношених і доношених новонароджених. Відзначається, що новонароджені мають високий ризик дихальних ускладнень під час анестезії, які можна пояснити особливістю їх фізіології дихання. Під час анестезії та хірургічного втручання може легко порушитися баланс між обсягом закриття та функціональною залишковою ємністю легенів, що відразу ж призведе до дихальних розладів. Тому стратегія вентиляційної терапії повинна включати методики «відкриття легенів», а також уникати високого дихального обсягу VT і зайвої концентрації кисню. При важкій дихальній недостатності часто використовується високочастотна осциляційна вентиляція (HFOV), хоча у недоношених дітей у порівнянні зі звичайною вентиляцією вона не має переваг у зниженні розвитку БЛД, летальних випадках, а також у частоті важких неврологічних ускладнень. Що стосується доношених новонароджених, то своєчасний початок HFOV може бути більш ефективним, ніж звичайна механічна вентиляція. Даний огляд стосується також таких питань, як застосування інгаляції оксиду азоту, використання ендотрахеальних трубок з манжетками або без, впливу анестетиків на легені у новонароджених, а також тих проблем з диханням, які можуть виникнути під час анестезії та операції. 


Ключові слова


Дихальна система; новонароджені; вентиляція.

Повний текст:

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Посилання


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