新生儿呼吸衰竭无创通气治疗策略的进展

Advances in Noninvasive Ventilation Strategies for Neonatal Respiratory Failure

摘要: 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。

Abstract: 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.