经鼻高流量氧疗在呼吸系统疾病中的应用进展
The Application Progress of HFNC in Respiratory Diseases
摘要: 经鼻高流量氧疗(HFNC)是通过空氧混合装置将可调节高流量高浓度、恒温加湿的氧气输送至患者端的氧疗方式,在呼吸系统疾病中的治疗效果明显优于一般氧疗(如鼻导管、面罩给氧等),且在某些方面可替代甚至优于无创辅助通气,目前在临床上已广泛应用,但是仍有部分适应症需更多循证医学依据,同时未纳入医保、费用较高导致在基层医院的应用受到一定限制。本文将从HFNC的主要构造、工作原理、生理学效应及在呼吸系统疾病中的应用进行综述。
Abstract: High-flow nasal cannula (HFNC) is an oxygen therapy method that delivers adjustable high-flow, high-concentration, constant temperature and humidified oxygen to the patient with an air-oxygen mixing device. The therapeutic effect in respiratory diseases is obviously better than that of general oxygen therapy (such as nasal cannula, mask oxygen, etc.), and it can replace or even be superior to non-invasive ventilation in some respects. HFNC is now widely used in clinic, but there are still some indications that require more evidence-based medical evidence, while the lack of health insurance coverage and high costs have limited its use in primary care. This article will review the main structure, working principle, physiological effect and application of HFNC in respiratory diseases.
文章引用:吴迪, 赵连波. 经鼻高流量氧疗在呼吸系统疾病中的应用进展[J]. 临床医学进展, 2022, 12(11): 10617-10624. https://doi.org/10.12677/ACM.2022.12111529

参考文献

[1] 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.
[2] Matthay, M.A. (2015) Saving Lives with High-Flow Nasal Oxygen. New England Journal of Medicine, 372, 2225-2226. [Google Scholar] [CrossRef
[3] Liew, Z., Fenton, A.C., Harigopal, S., et al. (2020) Physiological Ef-fects of High-Flow Nasal Cannula Therapy in Preterm Infants. Archives of Disease in Childhood Fetal and Neonatal Edition, 105, 87-93. [Google Scholar] [CrossRef] [PubMed]
[4] Onodera, Y., Akimoto, R., Suzuki, H., et al. (2018) A High-Flow Nasal Cannula System with Relatively Low Flow Effectively Washes out CO2 from the Anatomical Dead Space in a Sophisticated Respiratory Model Made by a 3D Printer. Intensive Care Medicine Experimental, 6, Article No. 7. [Google Scholar] [CrossRef] [PubMed]
[5] Riva, T., Meyer, J., Theiler, L., et al. (2021) Measurement of Airway Pressure during High-Flow Nasal Therapy in Apnoeic Oxygenation: A Randomised Controlled Crossover Trial. Anaesthesia, 76, 27-35. [Google Scholar] [CrossRef] [PubMed]
[6] Storgaard, L.H., Hockey, H.U., Laursen, B.S., et al. (2018) Long-Term Effects of Oxygen-Enriched High-Flow Nasal Cannula Treatment in COPD Patients with Chronic Hypoxemic Respira-tory Failure. International Journal of Chronic Obstructive Pulmonary Disease, 13, 1195-1205. [Google Scholar] [CrossRef
[7] Ruangsomboon, O., Limsuwat, C., Praphruetkit, N., et al. (2021) Nasal High-Flow Oxygen versus Conventional Oxygen Therapy for Acute Severe Asthma Patients: A Pilot Randomized Controlled Trial. Academic Emergency Medicine, 28, 530-541. [Google Scholar] [CrossRef] [PubMed]
[8] Koyauchi, T., Hasegawa, H., Kanata, K., et al. (2018) Efficacy and Tolerability of High-Flow Nasal Cannula Oxygen Therapy for Hypoxemic Respiratory Failure in Patients with Interstitial Lung Disease with Do-Not-Intubate Orders: A Retrospective Single-Center Study. Respiration, 96, 323-329. [Google Scholar] [CrossRef] [PubMed]
[9] Al Chikhanie, Y., Veale, D., Verges, S., et al. (2021) The Effect of Heated Humidified Nasal High Flow Oxygen Supply on Exercise Tolerance in Patients with Interstitial Lung Disease: A Pilot Study. Respiratory Medicine, 186, Article ID: 106523. [Google Scholar] [CrossRef
[10] Frat, J.P., Thille, A.W., Mercat, A., et al. (2015) High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure. The New England Journal of Med-icine, 372, 2185-2196. [Google Scholar] [CrossRef
[11] Mauri, T., Turrini, C., Eronia, N., et al. (2017) Physiologic Effects of High-Flow Nasal Cannula in Acute Hypoxemic Respiratory Failure. American Journal of Respiratory and Critical Care Medicine, 195, 1207-1215. [Google Scholar] [CrossRef
[12] Rochwerg, B., Granton, D., Wang, D.X., et al. (2019) High Flow Nasal Cannula Compared with Conventional Oxygen Therapy for Acute Hypoxemic Respiratory Failure: A Sys-tematic Review and Meta-Analysis. Intensive Care Medicine, 45, 563-572. [Google Scholar] [CrossRef] [PubMed]
[13] Lewis, S.R., Baker, P.E., Parker, R., et al. (2021) High-Flow Nasal Cannulae for Respiratory Support in Adult Intensive Care Patients. Cochrane Database of Systematic Reviews, 3, CD010172. [Google Scholar] [CrossRef
[14] Kang, B.J., Koh, Y., Lim, C.M., et al. (2015) Failure of High-Flow Nasal Cannula Therapy May Delay Intubation and Increase Mortality. Intensive Care Medicine, 41, 623-632. [Google Scholar] [CrossRef] [PubMed]
[15] Marti, S., Carsin, A.E., Sampol, J., et al. (2022) Higher Mortality and Intubation Rate in COVID-19 Patients Treated with Noninvasive Ventilation Compared with High-Flow Oxygen or CPAP. Scientific Reports, 12, Article No. 6527. [Google Scholar] [CrossRef] [PubMed]
[16] Bräunlich, J., Köhler, M. and Wirtz, H. (2016) Nasal High-Flow Improves Ventilation in Patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease, 11, 1077-1085. [Google Scholar] [CrossRef
[17] Sun, J., Li, Y., Ling, B., Zhu, Q., et al. (2019) High Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation for Chronic Obstructive Pulmonary Disease with Acute-Moderate Hypercapnic Respiratory Failure: An Observational Cohort Study. International Journal of Chronic Obstructive Pulmonary Disease, 14, 1229-1237. [Google Scholar] [CrossRef
[18] 陈颖, 万久贺, 王红, 郭晓华, 等. 无创通气与经鼻高流量氧疗治疗COPD合并II型呼吸衰竭的临床疗效[J]. 国际呼吸杂志, 2020, 40(20): 1570-1575.
[19] Kim, E.S., Lee, H., Kim, S.J., et al. (2018) Effectiveness of High-Flow Nasal Cannula Oxygen Therapy for Acute Respiratory Failure with Hypercapnia. Journal of Thoracic Disease, 10, 882-888. [Google Scholar] [CrossRef] [PubMed]
[20] Nam, K.H., Kang, H.K., Lee, S.S., et al. (2021) Effects of High-Flow Nasal Cannula in Patients with Mild to Moderate Hypercapnia: A Prospective Observational Study. Acute and Critical Care, 36, 249-255. [Google Scholar] [CrossRef] [PubMed]
[21] Pisani, L., Betti, S., Biglia, C., et al. (2020) Effects of High-Flow Na-sal Cannula in Patients with Persistent Hypercapnia after an Acute COPD Exacerbation: A Prospective Pilot Study. BMC Pulmonary Medicine, 20, Article No. 12. [Google Scholar] [CrossRef] [PubMed]
[22] Xia, J., Gu, S., Lei, W., et al. (2022) High-Flow Nasal Cannula versus Conventional Oxygen Therapy in Acute COPD Exacerbation with Mild Hypercapnia: A Multicenter Randomized Controlled Trial. Critical Care, 26, Article No. 109. [Google Scholar] [CrossRef] [PubMed]
[23] 李庆云, 李红鹏. 阻塞性睡眠呼吸暂停发病机制的探究和认识[J]. 中华结核和呼吸杂志, 2021, 44(10): 864-866.
[24] 苏琳凡, 肖毅. 阻塞性睡眠呼吸暂停的个体化治疗: 机遇与挑战[J]. 国际呼吸杂志, 2022, 42(9): 641-643.
[25] Gray, A.J., Nielsen, K.R., Ellington, L.E., et al. (2021) Tra-cheal Pressure Generated by High-Flow Nasal Cannula in 3D-Printed Pediatric Airway Models. International Journal of Pediatric Otorhinolaryngology, 145, Article ID: 110719. [Google Scholar] [CrossRef] [PubMed]
[26] Amaddeo, A., Khirani, S., Frapin, A., et al. (2019) High-Flow Nasal Cannula for Children Not Compliant with Continuous Positive Airway Pressure. Sleep Medicine, 63, 24-28. [Google Scholar] [CrossRef] [PubMed]
[27] Sakaguchi, Y., Nozaki-Taguchi, N., Hasegawa, M., et al. (2022) Combination Therapy of High-Flow Nasal Cannula and Upper-Body Elevation for Postoperative Sleep-Disordered Breathing: Randomized Crossover Trial. Anesthesiology, 137, 15-27. [Google Scholar] [CrossRef
[28] Tsai, F.C., Chen, N.L., Gobindram, A., et al. (2022) Effi-cacy of High Flow Nasal Cannula as an Alternative to Continuous Positive Airway Pressure Therapy in Surgical Patients with Suspected Moderate to Severe Obstructive Sleep Apnea. American Journal of Otolaryngology, 43, Article ID: 103295. [Google Scholar] [CrossRef] [PubMed]
[29] 张鹏, 李争, 江海娇, 等. IC机械通气患者拔管后应用经鼻高流量序贯氧疗的效果分析[J]. 中华危重病急救医学, 2021, 33(6): 692-696.
[30] Gaspari, R., Spinazzola, G., Ferrone, G., et al. (2020) High-Flow Nasal Cannula versus Standard Oxygen Therapy after Extubation in Liver Transplantation: A Matched Controlled Study. Respiratory Care, 65, 21-28. [Google Scholar] [CrossRef] [PubMed]
[31] Futier, E., Paugam-Burtz, C., Godet, T., et al. (2016) Effect of Early Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Hypoxaemia in Patients after Major Ab-dominal Surgery: A French Multicentre Randomised Controlled Trial (OPERA). Intensive Care Medicine, 42, 1888-1898. [Google Scholar] [CrossRef] [PubMed]
[32] 朱正方, 刘煜昊, 王启星, 等. 经鼻高流量氧疗用于机械通气脱机拔管后序贯治疗的初步评价[J]. 中华危重病急救医学, 2017, 29(9): 778-782.
[33] Granton, D., Chaudhuri, D., Wang, D., et al. (2020) High-Flow Nasal Cannula Compared with Conventional Oxygen Therapy or Noninvasive Venti-lation Immediately Postextubation: A Systematic Review and Meta-Analysis. Critical Care Medicine, 48, e1129-e1136. [Google Scholar] [CrossRef
[34] Thille, A.W., Monseau, G., Coudroy, R., et al. (2021) Non-Invasive Ventilation versus High-Flow Nasal Oxygen for Postextubation Respiratory Failure in ICU: A Post-Hoc Analysis of a Randomized Clinical Trial. Critical Care, 25, Article No. 221. [Google Scholar] [CrossRef] [PubMed]
[35] Thille, A.W., Muller, G., Gacouin, A., et al. (2019) Effect of Postextubation High-Flow Nasal Oxygen with Noninvasive Ventilation vs High-Flow Nasal Oxygen Alone on Reintu-bation among Patients at High Risk of Extubation Failure: A Randomized Clinical Trial. JAMA, 322, 1465-1475. [Google Scholar] [CrossRef] [PubMed]
[36] Kim, S.Y., Lee, H.J., Lee, J.K., et al. (2022) Association between Oxygen Saturation Level during Bronchoscopy and Post-Bronchoscopy Adverse Events: A Retrospective Cohort Study. Respiratory Research, 23, Article No. 144. [Google Scholar] [CrossRef] [PubMed]
[37] Wang, R., Li, H.C., Li, X.Y., et al. (2021) Modified High-Flow Nasal Cannula Oxygen Therapy versus Conventional Oxygen Therapy in Patients Undergoing Bronchoscopy: A Ran-domized Clinical Trial. BMC Pulmonary Medicine, 21, Article No. 367. [Google Scholar] [CrossRef] [PubMed]
[38] Sharluyan, A., Osona, B., Frontera, G., et al. (2021) High Flow Nasal Cannula versus Standard Low Flow Nasal Oxygen during Flexible Bronchoscopy in Children: A Randomized Controlled Trial. Pediatric Pulmonology, 56, 4001-4010. [Google Scholar] [CrossRef] [PubMed]
[39] Sampsonas, F., Karamouzos, V., Karampitsakos, T., et al. (2022) High-Flow vs. Low-Flow Nasal Cannula in Reducing Hypoxemic Events during Bronchoscopic Procedures: A System-atic Review and Meta-Analysis. Frontiers in Medicine, 9, Article ID: 815799. [Google Scholar] [CrossRef] [PubMed]
[40] Simon, M., Braune, S., Frings, D., et al. (2014) High-Flow Nasal Cannula Oxygen versus Non-Invasive Ventilation in Patients with Acute Hypoxaemic Respiratory Failure Undergoing Flexible Bronchoscopy—A Prospective Randomised Trial. Critical Care, 18, Article No. 712. [Google Scholar] [CrossRef] [PubMed]
[41] Pelaia, C., Bruni, A., Garofalo, E., et al. (2021) Oxygenation Strategies during Flexible Bronchoscopy: A Review of the Literature. Respiratory Research, 22, Article No. 253. [Google Scholar] [CrossRef] [PubMed]
[42] Jaber, S., Monnin, M., Girard, M., et al. (2016) Apnoeic Oxy-genation via High-Flow Nasal Cannula Oxygen Combined with Non-Invasive Ventilation Preoxygenation for Intubation in Hypoxaemic Patients in the Intensive Care Unit: The Single-Centre, Blinded, Randomised Controlled OPTINIV Trial. Intensive Care Medicine, 42, 1877-1887. [Google Scholar] [CrossRef] [PubMed]
[43] Guitton, C., Ehrmann, S., Volteau, C., et al. (2019) Nasal High-Flow Preoxygenation for Endotracheal Intubation in the Critically Ill Patient: A Randomized Clinical Trial. Intensive Care Medicine, 45, 447-458. [Google Scholar] [CrossRef] [PubMed]
[44] Simon, M., Wachs, C., Braune, S., et al. (2016) High-Flow Nasal Cannula versus Bag-Valve-Mask for Preoxygenation before Intubation in Subjects with Hypoxemic Respiratory Failure. Respiratory Care, 61, 1160-1167. [Google Scholar] [CrossRef] [PubMed]