臺灣博碩士論文加值系統

摘要
研究背景與目的：
經鼻加溫濕化高流量治療在新生兒加護病房被應用於早產兒的非侵襲性呼吸支持。這可以提供患者良好舒適護理治療方式。本研究欲藉由脫離經鼻持續正壓呼吸器過程中以經鼻加溫濕化高流量治療作為脫離經鼻持續正壓呼吸器的方式，來評估經鼻加溫濕化高流量治療所產生的壓力變化,並進一步分析影響高流量氧氣治療所產生的壓力因子為何。

研究方法：
本研究於高雄醫學大學附設醫院新生兒加護病房進行。納入研究的低體重早產兒（出生體重低於2500公克）於2015年3月至2015年8月期間參與使用經鼻加溫濕化高流量治療脫離呼吸器。參與本次研究的嬰兒的病情都在穩定狀態，能夠耐受脫離經鼻式連續性正壓呼吸器的過程。本研究使用了 Optiflow™ Junior 裝置，配備 MR 850 加濕器和嬰兒鼻套管（Fisher & Paykel Healthcare）。研究期間持續每天約 3 次使用 GiO 數字壓力計（GIO 6，GaleMed Corporation，台灣）監測鼻套管末端的平均壓力，將經鼻加溫濕化高流量治療產生的壓力設置為與經鼻持續正壓呼吸器的呼氣末端陽壓相同，而決定使用經鼻加溫濕化高流量治療的流速。使用 IBM SPSS Statistics V20.0 (SPSS Inc, IBM Corp, Armonk, NY) 收集和分析經鼻加溫濕化高流量治療所測得的壓力、流速、病嬰當時的體重和懷孕週數等數據。

研究結果：
共有9名低體重早產兒（4男5女）被納入研究。其平均出生週數為 28週 (標準差0週)，平均出生體重為1102.1公克 (標準差1公克)。分別對收集到的 437個使用經鼻加溫濕化高流量治療所監測得的壓力、流速和病嬰當時的體重資料進行分析。相關性分析顯示加溫濕化高流量治療所監測得的壓力與流速呈現正相關（相關係數 = 0.529，p<0.0001），與病嬰當時的體重也呈現正相關（相關係數 = 0.166，p<0.0001），也與病嬰當時的懷孕週數呈現正相關（相關係數 = 0.169，p<0.0001）。以流速、病嬰當時的體重及懷孕週數作為自變量，所監測得的壓力作為因變量進行多元迴歸分析。結果所得之多元迴歸模型是壓力 = -5.8 + 0.035 * 流速 (L/min) - 0.001 * 體重 (kg) + 1.021 * 懷孕週數。

結論：
結果顯示經鼻加溫濕化高流量治療所監測得的壓力會受流量及病嬰當時的體重及懷孕週數的影響。這些分析所得之資訊,可為我們提供關於低體重早產兒在使用經鼻加溫濕化高流量治療脫離經鼻式連續性正壓呼吸器的訊息。並且本研究也顯示，將經鼻加溫濕化高流量治療壓力設置為與經鼻式連續性正壓呼吸器的呼氣末端陽壓相同是可行的。

Abstract
Background：
Heated humidified high flow nasal cannula (HHHFNC) was used as noninvasive respiratory support for preterm infants in neonatal intensive care units. It is a strategy to provide good comfort care to patients. HHHFNC can be considered for the use as an alternative to nasal continuous positive airway pressure (NCPAP) during weaning processes. The pressure generated by HHHFNC may not be as stable as NCPAP.

Aim：
To evaluate the pressure generated by HHHFNC for respiratory support of preterm infants in the neonatal intensive care unit (NICU) of Kaohsiung Medical University Hospital.

Methods：
Low birth weight (LBW) infants (birth body weight < 2500g) who used HHHFNC to wean from NCPAP were enrolled from March 2015 to August 2015. The infants who participated in this HHHFNC study were in stable condition and were able to tolerate weaning from NCPAP. Optiflow™ junior device with the MR 850 humidifier and binasal infant cannula (Fisher & Paykel Healthcare) were used in this study. The study monitored the mean pressure at the distal end of nasal cannula with a GiO Digital Pressure Gauge (GIO 6, GaleMed Corporation, and Taiwan) for about three times a day. For this study, the pressure generated by HHHFNC was set up at the same level as positive expiratory pressure (PEEP) of NCPAP. The flow rate was adjusted to fit the pressure level while using of HHHFNC. The data of pressure, flow rate of HHHFNC, body weight and postmenstrual age by day (PMA(d)) were collected and analyzed using IBM SPSS Statistics V20.0 (SPSS Inc, IBM Corp, Armonk, NY).

Result：
Nine LBW premature infants (four males, five females) were enrolled in this study. The gestational age was 28 ± 0 weeks, and the average birth weight was 1102 ± 1g. Four hundred and thirty-seven samples of pressure, flow rate, body weight, and PMA(d) of HHHFNC were analyzed. Correlation analysis showed there were positive correlation between pressure and flow rate (correlation coefficient = 0.529, p<0.0001), between pressure and body weight (correlation coefficient = 0.166, p<0.0001), and between pressure and PMA(d) (correlation coefficient = 0.169, p<0.0001). Analysis performed with multiple regressions from flow rate, body weight, PMA(d) as the independent variables, and pressure as the dependent variable. The computed multiple regression models were Pressure = -5.8 + 0.035 * flow rate (L/min) - 0.001 * BW (kg) + 1.021 * PMA(d).

Conclusion：
The results show pressure generated by HHHFNC is influenced by flow rate, BW (kg) and PMA(d) of the infant while using HHHFNC. The data provide us information on delivered pressure of HHHFNC for LBW premature infants while weaning from NCPAP. It is workable to set up the pressure at the same level as PEEP or NCPAP while using HHHNC for premature infants.

Table of Contents
摘要 i
Abstract iv
致謝 vii
List of Tables x
List of Figures xi
Charter 1 Introduction 1
1.1 Background 1
1.2 Motivation 3
Charter 2 Literature Review 5
2.1 Preterm Infants 5
2.2 Oxygen Delivery Methods 5
2.3 NCPAP 6
2.4 HHHFNC 7
2.5 Comparison between NCPAP and HHHFNC 9
2.6 HHHFNC for Weaning from NCPAP 10
2.7 Previous Study for the Generated Pressure and Flow from HHHFNC 11
2.8 Aim of This Study 13
2.9 Patients and Method 13
2.10 HHHFNC Setting 16
Chapter 3 Results 17
3.1 The Characteristics of Enrolled Infants 17
3.2 Coefficient of Variation of the Pressure 19
3.3 Relationship Between Measured Pressure and Flow Rate During HHHFNC Use 20
3.4 Relationship Between Measured Pressure and Body weight During HHHFNC Use 21
3.5 Relationship Between Measured Pressure and Postmenstrual Age During HHHFNC Use 22
3.6 Multiple Regression Analysis 23
Chapter 4 Discussions 24
Chapter 5 Conclusion 35
References 36
Appendix I - IRB 44

List of Tables
Table 1. The Characteristics of Enrolled Infants 17
Table 2. Pressure of HHHFNC 18
Table 3. Individual Coefficient of Variation of the Pressure 19
Table 4. Multiple Regression Analysis 23

List of Figures
Figure 1. Optiflow™ Junior Device with MR 850 Humidifier and Binasal InfantCannula (Fisher & Paykel Healthcare) 14
Figure 2. MR 850 Humidifier 15
Figure 3. GIO 6, GaleMed Corporation, Taiwan 15
Figure 4. Pressure was monitored by means of the GiO Digital Pressure Gauge (GIO 6, GaleMed Corporation, Taiwan) from distal end of nasal cannulae three times per day. 16
Figure 5. Mean of Pressure 18
Figure 6. Relationship between Measured Pressure and Flow Rate 20
Figure 7. Relationship Between Measured Pressure and Body Weight 21
Figure 8. Relationship Between Measured Pressure and PMA(d) 22

 

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