无创呼吸支持治疗失败的影响因素研究进展

Research Progress on Factors Influencing the Failure of Non-Invasive Respiratory Support Treatment

摘要: 无创呼吸支持治疗是一种无需气管插管或气道切开，通过面罩、鼻罩等方式将呼吸机与患者相连，为患者提供呼吸支持的治疗方式。无创呼吸支持治疗是纠正血气指标异常和改善患者病情的重要手段。无创通气(Non-invasive ventilation, NIV)与经鼻高流量氧疗(High-flow nasal cannula, HFNC)是无创呼吸支持治疗的常用手段。无创通气是指呼吸机通过面罩与患者相连进行的正压通气，无需建立有创人工气道；而经鼻高流量氧疗是指通过鼻导管进行的高流量湿化氧疗，是一种高流量持续为患者提供可以调控并相对恒定吸氧浓度、温度以及湿度的吸入气体的治疗方式。对于无法耐受NIV的患者可以尝试使用HFNC代替治疗，且HFNC与NIV的治疗效果并没有太大差异。NIV失败(或HFNC失败)定义为患者使用NIV (或HFNC)一定时间后需要切换至有创通气或患者死亡。依据失败的时间点不同，NIV失败又可分为即刻失败(1小时内)、早期失败(1~48小时内)和晚期失败(48小时以后)，其中早期失败最为常见。盲目地使用无创通气，可能导致通气治疗早期失败并延后有创通气的启动时间，进而增加住院死亡率。因此，明确无创呼吸支持治疗的影响因素至关重要。本文对无创呼吸支持治疗的相关影响因素的研究进行综述，为临床治疗提供参考。

Abstract: Non-invasive respiratory support therapy is a treatment method that connects the patient to the ventilator through a mask, nasal mask, or other means without the need for endotracheal intubation or tracheotomy to provide respiratory support to the patient. Non-invasive respiratory support therapy is an important means to correct abnormal blood gas indicators and improve the patient’s condition. Non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) are common methods of non-invasive respiratory support therapy. Non-invasive ventilation refers to positive pressure ventilation through a mask connected to the ventilator without the need to establish an invasive artificial airway; while high-flow nasal cannula refers to high-flow humidified oxygen therapy through a nasal cannula, which is a treatment method that continuously provides the patient with inhalation gas with adjustable and relatively constant oxygen concentration, temperature, and humidity at a high flow rate. For patients who cannot tolerate NIV, HFNC can be attempted as an alternative treatment, and there is no significant difference in the therapeutic effect between HFNC and NIV. NIV failure (or HFNC failure) is defined as the need to switch to invasive ventilation or the patient’s death after a certain period of using NIV (or HFNC). According to the time point of failure, NIV failure can be divided into immediate failure (within 1 hour), early failure (1~48 hours), and late failure (after 48 hours), among which early failure is the most common. The blind use of non-invasive ventilation may lead to early failure of ventilation treatment and delay the initiation of invasive ventilation, thereby increasing the in-hospital mortality rate. Therefore, it is crucial to clarify the influencing factors of non-invasive respiratory support therapy. This article reviews research on the influencing factors of non-invasive respiratory support therapy to provide a reference for clinical treatment.