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

10.6142/VGHN.22.3.289

劉惠玲(Hui-Ling Liu)；游雅蘭(Ya-Lan Yu)；楊閔棻(Min-Fen Yang)

早產兒 ； 鼻式持續正壓呼吸器 ； 皮膚照護 ； prematurity ； nasal continuous positive airway pressure ； skin care

榮總護理

22卷3期（2005 / 09 / 01）

289 - 296

繁體中文

裝戴鼻式持續正壓呼吸器常作爲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1500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67%。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1500公克早產兒鼻中膈前端與鼻孔內緣發紅率由67%降至23%。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 for treatment of respiratory distress syndrome and maintains airway stability after extubation. During the use of NCPAP, the patients often suffers erythematous injury 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 prong over anterior nasal septum and the skin of the infants, incomplete protection of Duoderm, prolonged use of NCPAP, and looseness of cap materials. In November 2003, we developed a standard procedure for wearing and fixing NCPAP. Two months later, the prevalence of nasal erythematous injuries was reduced from 67% to 23%. We believe that using this standard procedure can decrease the prevalence of skin injury of NCPAP.