经鼻高流量湿化氧疗在慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者中的临床疗效

摘要 目的：探讨经鼻高流量湿化氧疗（HFNC）在慢性阻塞性肺疾病急性加重期（AECOPD）合并Ⅱ型呼吸衰竭患者中的临床疗效。方法：将90例AECOPD合并Ⅱ型呼吸衰竭患者随机分为对照组和观察组，每组45例。在抗感染、解痉平喘、祛痰、营养支持等常规治疗基础上，对照组给予无创正压通气（NPPV）、观察组予以HFNC治疗，疗程均为7d。比较2组患者治疗前、治疗1d及7d后动脉血气分析指标（PaO2、PaCO2）、氢离子浓度指数（pH）、平均动脉压（MAP）、心率、呼吸频率、C反应蛋白（CRP）、白细胞介素6（IL-6）、肿瘤坏死因子-α（TNF-α）、生存质量 [圣•乔治医院呼吸疾病调查问卷（SGRQ）评分]、舒适状况量表（GCQ）评分、住院时间及不良反应。结果：治疗1d、7d后，2组PaO2、pH值及GCQ评分较治疗前升高，且治疗7d后高于治疗1d后，观察组GCQ评分高于对照组（P均<0.05）；PaCO2、MAP、心率、呼吸频率及SGRQ评分较治疗前降低，且治疗7d后低于治疗1d后，观察组SGRQ评分低于对照组（P均<0.05）。治疗7d后，观察组心率及呼吸频率低于对照组，2组CRP、IL-6、TNF-α水平较治疗前降低，且观察组低于对照组（P均<0.05）。观察组平均住院时间短于对照组，不耐受、面部压伤、鼻腔出血及胃肠胀气发生率低于对照组（P均<0.05）。结论：HFNC与NPPV均是AECOPD合并Ⅱ型呼吸衰竭呼吸支持治疗的有效方式，但HFNC在改善临床症状、缓解炎性反应及舒适耐受性方面更具优势，可显著提高生存质量，降低不良反应发生率。     

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...     

经鼻高流量氧疗辅助治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭临床观察

目的 探讨经鼻高流量氧疗辅助治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭患者的临床效果。方法 选择AECOPD合并Ⅱ型呼吸衰竭患者80例,根据通气治疗方式不同分为观察组和对照组各40例。两组均采取抗感染、化痰、解痉、扩张支气管以及黏液溶解、维持酸碱和电解质平衡等常规治疗。在常规治疗基础上,对照组予呼吸机常规无创正压通气治疗,观察组予湿化氧疗仪经鼻高流量氧疗,两组均连续治疗7 d。治疗前、治疗24 h和治疗7 d,采用血气分析仪检测血液pH、PaO₂、PaCO₂,采用心电监护仪检测心率(HR)、呼吸频率(RR)和平均动脉压(MAP)。治疗前和治疗7 d,采用全自动血细胞分析仪检测中性粒细胞与淋巴细胞比值(NLR),采用半定量固相免疫法检测血清降钙素原(PCT),采用酶联免疫法检测血清肿瘤坏死因子α(TNF-α)。治疗7 d,采用Kolcaba根据舒适分类结构编制的舒适状况量表(GCQ)评分评估治疗舒适度,评估临床疗效和不良事件情况。结果 两组治疗前血液pH、PaO₂、PaCO₂、HR...     

经鼻高流量氧疗在呼吸危重症中的应用

经鼻高流量氧疗是新型的呼吸支持技术,近年来在临床中迅速普及推广。其在许多呼吸功能不全的疾病中得到广泛应用,例如急性低氧性呼吸衰竭、伴高碳酸血症的呼吸衰竭以及辅助有创通气气管插管拔管等方面。然而,经鼻高流量氧疗仍缺乏高质量证据证实其有效性,因此临床中使用时更应谨慎把握适应证。     

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。     

无创正压通气间歇期使用经鼻高流量氧疗与鼻导管氧疗治疗老年慢性阻塞性肺疾病急性加重呼吸衰竭的临床分析

目的 探讨无创正压通气(non-invasive positive pressure ventilation,NPPV)间歇期使用经鼻高流量氧疗(high-flow nasal cannula oxygen therapy,HFNC)与鼻导管氧疗对老年慢性阻塞性肺疾病急性加重(AECOPD)呼吸衰竭患者的肺通气功能和动...     

经鼻高流量湿化氧疗治疗AECOP D合并Ⅱ型呼吸衰竭的疗效分析

目的 研究经鼻高流量湿化氧疗治疗慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭的疗效.方法 回顾性分析四川大学华西医院2017年10月至2020年2月诊治的60例AECOPD合并Ⅱ型呼吸衰竭患者病例作为研究对象,采用非随机临床同期对照研究及患者自愿原则法分为氧疗组28例和对照组32例,其中对照组接受无创正压通...     

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。     

Effectiveness of high-flow nasal cannula on pulmonary rehabilitation in subjects with chronic respiratory failure

BackgroundThe effects of exercise training using both high fraction of inspired oxygen (F_IO₂) and high flow oxygen delivered through a high-flow nasal cannula (HFNC) on exercise capacity in patients with chronic respiratory failure (CRF) receiving long-term oxygen therapy (LTOT) are unknown.MethodsIn this randomized study, 32 patients with CRF receiving LTOT were assigned to undergo 4 weeks of exercise training on a cycle ergometer using an HFNC (flow: 50 L/min) with a F_IO₂ of 1.0 (HFNC group; n = 16) or ordinary supplemental oxygen via a nasal cannula (flow: 6 L/min) (oxygen group; n = 16). A 6-min walking test and a constant-load test were performed before and after 4 weeks of exercise training.ResultsFollowing 4 weeks of exercise training, change in the 6-min walking distance was significantly greater in the HFNC than in the oxygen group (55.2 ± 69.6 m vs. −0.5 ± 87.3 m; p = 0.04). However, there was no significant difference between the two groups in the degree of improvement in the duration of the constant-load exercise test after exercise training.ConclusionsConsidering the effect on daily activities (e.g., walking), exercise training using both high F_IO₂ and high flow through an HFNC is a potentially superior exercise training modality for patients with CRF receiving LTOT.Clinical Trial Registration — http://www.clinicaltrials.gov. Unique identifier: NCT02804243     

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.     

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.

High-flow nasal cannula oxygenation utilization in respiratory failure

High flow nasal cannula (HFNC) represents a new oxygenation system to be used in the treatment of respiratory emergencies. During HFNC therapy, the active humidification and air heating system allow the patient to tolerate higher flows by favouring physiologic mucociliary clearance and improving fluidity of respiratory secretions. Following this, FiO₂ values are more stable and reliable, by reducing losses and minimizing ambient air entrainment. Several clinical trials in acute respiratory failure patients have suggested lower rate of invasive mechanical ventilation, improved comfort and enhanced survival by early HFNC utilization in comparison with conventional oxygen therapy (COT) or non-invasive ventilation (NIV). This review aims to summarize the main evidences on the use of HFNC in the acute setting and its major indications.     

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.