诊疗方案
ENGLISH ABSTRACT
成人经鼻高流量湿化氧疗临床规范应用专家共识
中华医学会呼吸病学分会呼吸危重症医学学组
中国医师协会呼吸医师分会危重症医学工作委员会
作者及单位信息
·
DOI: 10.3760/cma.j.issn.1001-0939.2019.02.003
Expert consensus of high⁃flow nasal cannula oxygen therapy on clinical application regularity
Respiratory & Critical Care Medicine Group of Chinese Thoracic Society
Respiratory & Critical Care Medicine Committee of Chinese Association of Chest Physician
Authors Info & Affiliations
Respiratory & Critical Care Medicine Group of Chinese Thoracic Society
Respiratory & Critical Care Medicine Committee of Chinese Association of Chest Physician
·
DOI: 10.3760/cma.j.issn.1001-0939.2019.02.003
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摘要

经鼻高流量湿化氧疗(HFNC)作为一种新的呼吸支持技术近些年来在临床得到广泛应用,该治疗设备主要包括空氧混合装置、湿化治疗仪、高流量鼻塞以及连接呼吸管路,主要关注于给患者提供相对恒定的吸氧浓度(21%~100%)、温度(31~37 ℃)和湿度的高流量(8~80 L/min)气体,并通过鼻塞进行氧疗,具有很好的舒适性。HFNC能够通过吸入高流量气体产生一定水平的呼气末正压、冲刷上呼吸道生理死腔、恒温恒湿的气体维持黏液纤毛清除系统功能以及降低患者上气道阻力和呼吸功等作用改善患者的换气和部分通气功能,对单纯低氧性呼吸衰竭(Ⅰ型呼吸衰竭)患者具有积极的治疗作用,对部分轻度低氧合并高碳酸血症(Ⅱ型呼吸衰竭)患者可能也具有一定的治疗作用,但尚需要大样本的临床研究证实。需要指出的是,HFNC的局限性也应正确认识。明确其适应证和禁忌证、规范临床应用势在必行,中华医学会呼吸病学分会呼吸危重症医学学组和中国医师协会呼吸医师分会危重症医学工作委员会牵头撰写成人经鼻高流量湿化氧疗临床规范应用专家共识,对规范国内HFNC的临床应用具有积极的意义。

引用本文

中华医学会呼吸病学分会呼吸危重症医学学组,中国医师协会呼吸医师分会危重症医学工作委员会. 成人经鼻高流量湿化氧疗临床规范应用专家共识[J]. 中华结核和呼吸杂志,2019,42(2):83-91.

DOI:10.3760/cma.j.issn.1001-0939.2019.02.003

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2014年经鼻高流量湿化氧疗(high-flow nasal cannula oxygen therapy,HFNC)在中国内地开始应用,短短几年内在临床上得到快速普及推广,其临床疗效得到临床医生的广泛认可,国际著名杂志近些年来也相继发表了多篇大样本前瞻性临床研究,证明了HFNC在轻中度单纯低氧性呼吸衰竭(Ⅰ型呼吸衰竭)的治疗价值 [ 1 ]。与传统氧疗、无创正压通气(non-invasive positive pressure ventilation,NPPV)及有创正压通气(invasive positive pressure ventilation,IPPV)比较,HFNC如何定位?如何规范应用?为此,中华医学会呼吸病学分会呼吸危重症医学学组及中国医师协会呼吸医师分会危重症医学工作委员会组织相关专家特制定本专家共识,以指导临床规范应用HFNC。本共识英文文献检索以Pubmed、Embase和Cochrane Central Register of Controlled Trails(CENTRAL)databases数据库内容为基础,检索词为"HFNC"或"high-flow nasal cannula"或"high-flow oxygen therapy"或"nasal high-flow oxygen therapy"。中文文献检索以中国生物医学文献数据库、维普中文生物医学期刊数据库、万方医学数据库和中国学术期刊网络出版总库这4个数据库收录文献为基础,使用"高流量氧疗"或"高流量湿化氧疗"作为关键词进行检索。对于纳入的文献进一步追溯其参考文献。对上述检索结果进行人工核对,排除以下3项:(1)与检索内容无相关性;(2)动物实验研究;(3)研究对象未满18周岁的临床研究。证据等级标准为:Ⅰ级:高质量的随机对照研究、权威指南以及高质量系统综述和荟萃分析;Ⅱ级:有一定研究局限性的RCT研究(如无隐蔽分组、未设盲法、未报告失访)、队列研究、病例系列研究及病例对照研究;Ⅲ级:病例报道、专家意见 [ 2 ]
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备注信息
A
解立新,解放军总医院呼吸与危重症医学科,北京100086,Email: mocdef.6ab21103xleix;詹庆元,中日友好医院呼吸与危重症医学科,北京100022,Email: mocdef.3ab615190yqnahz
B
感谢陈荣昌教授、梁宗安教授和中华医学会呼吸病学分会呼吸危重症医学学组及中国医师协会呼吸医师分会危重症医学工作委员会其他专家对本共识提出的宝贵意见
C
所有作者均声明不存在利益冲突
D
国家十三五重点研发计划 (2016YFC1304300,2018ZX09201013)
国家老年疾病临床医学研究中心课题 (NCRCG-PLAGH-2017003)
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