经鼻高流量氧疗

经鼻高流量氧疗(high-flow nasal oxygen,HFNO)是一种新型的氧疗技术,近年来开始逐步在临床普及应用。经过临床研究的不断探索,发现HFNO相较于传统氧疗具有诸多优势,并且在部分呼吸衰竭患者中的应用效果与无创通气相似,这为呼吸衰竭患者的呼吸支持提供了新的选择和思路。但其临床具体适应证仍不明确,因此现阶段应重视HFNO的临床使用规范,而其适用范围仍需临床研究的进一步探索。该文就其研究概况进行综述。     

经鼻高流量氧疗治疗急性呼吸衰竭的参数设置

经鼻高流量氧疗广泛应用于急性呼吸衰竭治疗,可以改善患者氧合状况、呼吸功和肺脏气体分布.通过调整氧浓度、湿化罐温度和气体流量三个参数,经鼻高流量氧疗提供高浓度氧气、湿化吸入气体和高流量气体.气体温度过低会影响呼吸道黏液纤毛功能,温度过高则影响患者舒适性.气体流量过低不但降低吸入氧气浓度,改善呼吸功作用也有限.为保证最佳治...     

经鼻高流量氧疗在合并共病的老年急性呼吸衰竭病人中的应用价值

目的 探索经鼻高流量氧疗(high-flow nasal insufflation,HFNI)在合并共病的老年急性呼吸衰竭病人中的治疗效果,期望为病人提供安全且更加舒适、耐受的供氧方式.方法 通过对HFNI与无创通气(nonin-vasive ventilation,NIV)进行比较,分析其在合并共病的老年急性呼吸衰竭...     

经鼻高流量湿化氧疗在肺水肿治疗中的临床意义及研究

目的 研究经鼻高流量湿化氧疗在肺水肿治疗中的临床意义.方法 本次纳入2020年1月至2020年7月收治的30例心源性肺水肿患者展开研究,按照随机数字表法分为两组,对照组15例予以传统面罩吸氧,观察组15例实施经鼻高流量湿化氧疗.将两组的血气分析结果、心率、呼吸频率、平均动脉压、呼吸困难指数、舒适度、Tei指数、血清BN...     

经鼻高流量湿化氧疗在心脏外科术后行支气管镜检查的应用

目的：优化心脏外科术后发生肺部并发症患者接受支气管镜检查时的氧疗方案。 方法：回顾分析2018年至2019年在我科接受心脏外科手术后行支气管镜检查的成年患者临床资料。根据氧疗方式不同，分为常规氧疗组（COT组）及经鼻高流量氧疗组（HFNC组）。COT组术中予以经湿化瓶双侧鼻导管吸氧，气体流量6L/min。HFNC组术中采用费雪派克呼吸湿化氧疗仪（Fisher & Parker AIRVOTM ）,气体流量60L/min，加温至37℃，FiO2=0.45。术后全组患者均予以经湿化瓶双侧鼻导管吸氧，气体流量6L/min。记录全组患者支气管镜检查时间。记录患者接受支气管镜检查前（T0）、检查时（T1）及检查结束后15min（T2）生命体征及动脉血气分析。记录两组患者术后视觉模拟评分量表（visual analog scale，VAS）评分。 结果：127例患者入选本次研究，COT组61例，HFNC组66例。支气管镜检查前，两组患者各项参数间无统计学差异。两组患者检查后氧合情况（SPO2、PaO2）较检查前均有所改善，且HFNC组患者氧合改善情况显著高于COT组。对照各时间点生命体征指标情况，HFNC组患者生命体征较COT组波动幅度小、更为平稳。另一方面，HFNC组患者平均检查时间（14.74±1.88）min显著短于COT组（17.21±1.81）min，检查过程中不良事件发生率低于COT组（1/19），术后VAS评分亦（2.45±1.35）显著低于COT组（4.72±1.07）(P<0.05)。 结论：HFNC的应用可以优化心脏外科术后发生肺部并发症患者接受支气管镜检查的过程，使患者更安全、更平稳、更配合、更快速地完成检查。     

经鼻高流量氧疗在慢性阻塞性肺疾病患者中的应用进展

经鼻高流量氧疗在呼吸危重症领域的应用研究进展迅速,它通过无需密封接口的鼻塞导管输送充分温湿化的精确浓度(21.0%～100.0%)的高流量(高达80 L/min)气体,能减少有创以及无创机械通气的概率,与传统氧疗方式相比有明显优势。但作为新型的呼吸支持工具,需要结合现有临床研究证据及病理生理机制,合理选择慢性阻塞性肺疾...     

经鼻高流量湿化氧疗对呼吸衰竭患者治疗的研究进展

氧疗是急性呼吸衰竭的一线治疗策略,其中非侵入性氧疗包括无创正压通气(NPPV)、标准氧(鼻导管吸氧)和经鼻高流量(HFNC)湿化氧疗.HFNC是新型辅助呼吸方式,近几年在临床上得到快速普及并推广.虽然HFNC是一种新型的呼吸支持技术,但其在临床的规范使用和适用范围尚需进一步临床研究.为了能更好地挽救患者生命,并积极促进...     

经鼻高流量氧疗对减少呼吸衰竭患者气管插管率有效性的meta分析

目的 评价经鼻高流量氧疗减少呼吸衰竭气管插管的有效性.方法 计算机检索中国期刊全文数据库(建库至2016年8月)、Cochrane图书馆(建库至2016年8月)、万方数据库(建库至2016年8月)、维普数据库(VIP)(建库至2016年8月)及PubMed(1995年至2016年8月)公开发表的中英文文献中关于高流量氧疗治疗呼吸衰竭的随机对照试验(RCTs),同时对纳入的研究进行偏倚风险判断,结果采用RevMan5.3进行meta分析.结果 纳入6篇相关文献.共纳入1041例患者,其中治疗组(经鼻高流量氧疗)患者467例,对照组(常规氧疗/无创通气)患者574例.治疗组中气管插管106例,对照组187例.结果表明高流量氧疗与常规氧疗/无创通气治疗相比减少呼吸衰竭气管插管率,差异有统计学意义[OR=0.72,95%C I(0.54~0.96),P<0.05].结论 经鼻高流量氧疗在呼吸衰竭治疗中可能减少气管插管率.     

1 例经鼻高流量湿化氧疗重型新冠肺炎患者的护理体会

本文总结了1 例经鼻高流量湿化氧疗(HFNC)的重型新型冠状病毒肺炎(简称新冠肺炎)患者的诊疗和护理过程。笔者认为,经鼻高流量湿化氧疗(HFNC)是改善重型患者呼吸窘迫等症状的重要治疗手段。在护理过程中,要加强对患者生命体征和氧合情况的监护,根据动脉血气及临床表现及时调整鼻高流量湿化氧疗(HFNC)参数,同时要给予患者充分的沟通和关怀,及时改善患者不良情绪,加快重型新冠肺炎患者的康复。     

Implementation of bronchoalveolar lavage using a high-flow nasal cannula in five cases of acute respiratory failure

In recent clinical practice, high-flow nasal cannula (HFNC) therapy has been used to improve oxygenation in adults with acute respiratory failure (ARF). However, bronchoscopy using HFNC in ARF has not yet been reported. Herein, we describe 5 cases of ARF where bronchoalveolar lavage (BAL) was employed successfully using an HFNC. We were able to discontinue or reduce the HFNC fraction of inspired oxygen (FiO₂) 30 min after completion of the bronchoscopy. Only 1 patient needed non-invasive positive pressure ventilation for 16 h after bronchoscopy. The HFNC may be a useful tool for ARF patients who require bronchoscopy.     

经鼻高流量湿化氧疗在COPD合并呼吸衰竭病人肺康复中的近期及远期疗效研究

目的探讨高流量湿化氧疗对COPD合并呼吸衰竭病人血气指标、肺部功能,近期、远期疗效的影响。方法以我院2017年1月至2020年5月老年病科收治的82例COPD合并呼吸衰竭病人作为观察对象,分为观察组42例和对照组40例。观察组病人给予高流量湿化氧疗,对照组给予无创正压通气治疗,比较2组病人干预后3 d的血气指标、肺功能、治疗效果、并发症发生情况及6个月后6分钟步行距离(6MWD)及改良英国医学研究委员会呼吸困难指数(mMRC)、COPD评估测试(CAT)评分、Borg评分与BODE指数结果。结果治疗3 d后,观察组病人PaO_(2)、FEV1、FEV1占预计值百分比、FVC占预计值百分比、FEV1/FVC均高于对照组(P<0.05),PaCO_(2)水平低于对照组(P<0.05);观察组的治疗有效率(92.85%)高于对照组(57.50%),2组并发症发生率差异无统计学意义(P>0.05)。随访6个月后,观察组6MWD、mMRC评分高于对照组(P<0.05),CAT评分、Borg评分及BODE指数低于对照组(P<0.05)。结论高流量湿化氧疗可改善COPD合并呼吸衰竭病人的血气指标和肺功能,改善疾病预后,值得临床应用。     

Clinical outcomes of high-flow nasal cannula oxygen therapy in acute heart failure patients with hypoxemia: A retrospective cohort study

Acute heart failure (AHF) is life-threatening medical condition requiring hospital admission and appropriate oxygen therapy. High flow nasal cannula oxygen therapy (HFNC) has gained its popularity in treatment of AHF, however, there were less studies have demonstrated the physiological efficacy of HFNC. Purpose of this study was to evaluated the physiological responses and clinical outcomes of HFNC by comparing with noninvasive positive pressure ventilation (NPPV) therapy. A retrospective cohort investigation was conducted at emergency intensive care unit (EICU) and cardiovascular center of our hospital from June 2019 to March 2022, AHF patients with hypoxemia were reviewed. According to the received oxygen therapy model, patients were divided into HFNC and NPPV groups. Demographic data, arterial blood gas (ABG) parameter, echocardiography findings, complications and other related variables were extracted and collected from the electronic medical records (EMRs) by well-trained investigators. Physiological responses and clinical outcomes within and between 2 groups were analyzed. Finally, 156 patients with a mean age of 69.3 ± 7.1 years were reviewed, there were 82 (52.6%) male and 74 (47.4%) female patients in the sample and 70 (44.9%) and 86 (55.1%) patients classified III and IV score were included in this study, 80 patients received HFNC and 76 underwent NPPV oxygen therapy. There were no significant differences of baseline characteristics for the 2 groups patients. Changes of left ventricular function parameters, ABG and clinical outcomes were all improved satisfactorily after 24 h medical interventions in both group, what’s more, patients underwent HFNC therapy could acquire a better amelioration when compared with NPPV groups (P < .05). HFNC may be an ideal model for patients with AHF, particularly those with hypoxemia. HFNC therapy could significantly improve several objective parameters of physiological responses and clinical outcomes.     

The clinical practice of high-flow nasal cannula oxygen therapy in adults: A Japanese cross-sectional multicenter survey

Background

High-flow nasal cannula oxygen therapy (HFNC) is widely used mainly in the acute care setting, but limited data are available on real-world practice in adults. The objective of this study was to describe HFNC practices in Japanese adults.

节氧鼻导管的研制及其在氧疗中的节氧效率的观察

目的　研制节氧鼻导管,并探讨其在慢性阻塞性肺疾病（ＣＯＰＤ） 患者中的节氧效率。方法　（１）利用吸气相给氧呼气相贮氧的原理,设计并制作节氧鼻导管;（２） 氧疗效果评定：在不同的氧流量（０－５、１－０、１－５、２－０ Ｌ／ｍｉｎ）下,采用随机、平行、交叉、对照方法,对节氧鼻导管及普通鼻导管氧疗２ 小时前后的动脉血气值进行分析,并监测氧疗后不同时间（１、３ 、５、１０、１５、３０、６０、１２０ ｍｉｎ）的经皮血氧饱和度（ＳｐＯ２）;（３）节氧效率评定：在不同的氧流量（０－５、１－０、１－５、２－０、２－５、３－０ Ｌ／ｍｉｎ）下,测定采用节氧鼻导管、国外同类产品、普通鼻导管氧疗５ 分钟前后的ＳｐＯ２ 值。结果　（１） 在不同的氧流量下,节氧鼻导管组氧疗２ 小时后,ＰａＯ２ 与ＳａＯ２ 值均较普通鼻导管组高（Ｐ＜０－０５）。（２） 在不同的氧流量下节氧效率分别为：氧流量０－５ Ｌ／ｍｉｎ 时节氧鼻导管的节氧效率为普通鼻导管的２－６ 倍;１－０ Ｌ／ｍｉｎ 时为１－８ 倍;１－５ Ｌ／ｍｉｎ 时为１－８ 倍;２－０ Ｌ／ｍｉｎ 时为１－５ 倍。（３） 节氧鼻导管与国外同类产品比较,节氧效率无显著差异（ Ｐ＞ ０－０５）。结论　节氧鼻导管的节氧效     

Predictors of high flow oxygen therapy failure in COVID-19-related severe hypoxemic respiratory failure

BackgroundDuring COVID-19 pandemic, people who developed pneumonia and needed supplemental oxygen, where treated with low-flow oxygen therapy systems and non-invasive methods, including oxygen therapy using high flow nasal cannula (HFNC) and the application of bi-level or continuous positive airway pressure (BiPAP or CPAP). We aimed to investigate the outcomes of critical COVID-19 patients treated with HFNC and unveil predictors of HFNC failure.MethodsWe retrospectively enrolled patients admitted to COVID-19 wards and treated with HFNC for COVID-19-related severe hypoxemic respiratory failure. The primary outcome of this study was treatment failure, such as the composite of intubation or death during hospital stay. The association between treatment failure and clinical features was evaluated using logistic regression models.ResultsOne hundred thirty-two patients with a median (IQR) PaO₂/FiO₂ ratio 96 (63–173) mmHg at HFNC initiation were studied. Overall, 45.4% of the patients were intubated. Hospital mortality was 31.8%. Treatment failure (intubation or death) occurred in 50.75% and after adjustment for age, gender, Charlson Comorbidity index (CCI) score and National Early Warning Score 2 (NEWS2) score on admission and PaO₂/FiO₂ ratio and acute respiratory distress syndrome (ARDS) severity at the time of HFNO initiation, it was significantly associated with the presence of dyspnea [adjusted OR 2.48 (95% CI: 1.01–6.12)], and higher Urea serum levels [adjusted OR 1.25 (95% CI: 1.03–1.51) mg/dL].ConclusionsHFNC treatment was successful in almost half of the patients with severe COVID-19-related acute hypoxemic respiratory failure (AHRF). The presence of dyspnea and high serum Urea levels on admission are closely related to HFNC failure.