採用鼻式持續正壓呼吸器早產兒皮膚受壓改善方案

The Strategy for Reducing Skin Compression through Nasal Continuous Positive Airway Pressure Used for Prematurity

裝戴鼻式持續正壓呼吸器常作為早產兒呼吸窘迫症與氣管內管拔除後，維持吐氣正壓促肺泡擴張的呼吸治療方式，但治療期間卻常出現鼻中膈前端與鼻孔內緣發紅破皮的現象。本專案的目的即是要降低裝戴鼻式持續正壓呼吸器早產兒的鼻中膈前端與鼻孔內緣破皮發紅的比率。根據病房統計，小於公克的早產兒裝戴鼻式持續正壓呼吸器鼻部皮膚發紅比率達。分析主要原因有鼻套管緊密壓迫鼻中膈前端、鼻套管摩擦皮膚、人工皮保護不完整、長期持續裝戴及帽襪材質鬆脫等。故於九十二年十一月成立專案小組，發展出裝戴鼻式持續正壓呼吸器鼻套管固定新方式並將此技術標準化。推展二個月後，小於公克早產兒鼻中膈前端與鼻孔內緣發紅率由降至。盼此新方式，能提昇早產兒皮膚照護品質，嘉惠更多早產兒。

Nasal continuous positive airway pressure (NCPAP) is a common device fortreatment of respiratory distress syndrome and maintains airway stability afterextubation. During the use of NCPAP, the patients often suffers erythematousinjury or even erosion of anterior nasal septum and nostrils.The purpose of this study was to reduce the prevalence of these skin complications.According to our observation, the main causes were tight compression of prongover anterior nasal septum and the skin of the infants, incomplete protection ofDuoderm, prolonged use of NCPAP, and looseness of cap materials. In November2003, we developed a standard procedure for wearing and fixing NCPAP. Two monthslater, the prevalence of nasal erythematous injuries was reduced from 67% to 23%.We believe that using this standard procedure can decrease the prevalence of skininjury of NCPAP.