经鼻高流量氧疗治疗急性失代偿性心衰患者的研究进展
Journal: Basic Medical Theory Research DOI: 10.12238/bmtr.v7i4.15529
Abstract
急性失代偿性心衰患者通常伴有不同程度的呼吸困难或低氧血症,寻找合适的氧疗方式以改善组织供氧是治疗心衰的一项重要措施。临床常用文丘里面罩或鼻导管给氧,此种氧疗方式常给患者的鼻咽部带来不适及面部压迫感。而采用无创机械通气虽能有效减轻肺水肿,改善心衰带来的低氧血症,但临床使用舒适性差,常因不能耐受而中断治疗,并增加护理难度。近年兴起的加温加湿经鼻导管高流量氧疗,因其可提供恒定流量、浓度的氧气,且具备恒温、恒湿的优点,在临床中被广泛应用。另外,因其可产生呼气末正压并增加呼气末容积、降低心脏前负荷及降低呼吸做功、减少解剖死腔和清除二氧化碳、增加肺通气以改善呼吸困难症状等作用,逐渐在心衰的救治中被重视,因此本文对其在急性失代偿性心衰治疗中作为呼吸支持的生理效应及机制进行综述,以期为急性失代偿性心衰患者住院治疗的呼吸支持方式提供更多参考。
Keywords
加温加湿经鼻高流量吸氧；HFNC；氧疗；急性失代偿性心衰
Funding
青海省人民医院院内课题。
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[26] 中国医师协会急诊医师分会,中华医学会急诊医学分会,中国急诊专科医联体,北京急诊医学学会.急诊成人经鼻高流量氧疗临床应用专家共识.中华急诊医学杂志,2021,30(9):1041-1050.
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[28] 陆广生.不同流速经鼻高流量氧疗治疗充血性心力衰竭患者的疗效比较[D].广州医科大学,2022.
[2] 中国老年医学学会心电及心功能分会,中国医师协会心血管内科分会,中国心衰中心联盟专家委员会.慢性心力衰竭加重患者的综合管理中国专家共识2022.中国循环杂志,2022,37(3):215-225.
[3] 李庆印,李峥,康晓凤,等.成人急性心力衰竭护理实践指南[J].中国护理管理,2016,16(09):1179-1188.
[4] Adhikari P, Bhattarai S,Gupta A,et al.Physiological Eff ects of High-Flow Nasal Cannula Therapy and Its Use in Acute Cardiogenic Pulmonary Edema.Cureus.2021.13(2):13372.
[5] D'Cruz RF,Hart N,Kaltsakas G.High-flow therapy: physiol ogical effects and clinical applications. Breathe (Sheff).2020.16(4):200224.
[6] Nishimura M. High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits,Indication, Clinical Benefits, and Adverse Effects.Respir Care.2016.61(4):529-41.
[7] Yan L, Lu Y, Deng M, et al. Efficacy of high-flow nasal cannula in patients with acute heart failure: a systematic review and meta-analysis.BMC Pulm Med.2023.23(1):476.
[8] Niu J,He Z,Zha S,et al.Efficacy of positive airway press ure therapy and high flow nasal cannula oxygen in acute cardio genic pulmonary oedema:A protocol for systematic review and network meta-analysis.Front Med (Lausanne).2022.9:992491.
[9] Mauri T, Alban L, Turrini C, et al. Optimum support by high-flow nasal cannula in acute hypoxemic respiratory failu re: effects of increasing flow rates. Intensive Care Med. 2017.43(10):1453-1463.
[10] Parke RL,Bloch A,McGuinness SP.Effect of Very-HighFlow Nasal Therapy on Airway Pressure and End-Expiratory Lung Impedance in Healthy Volunteers.Respir Care.2015.60(10):1397-403.
[11] Spicuzza L,Schisano M.High-flow nasal cannula oxyg en therapy as an emerging option for respiratory failure: the present and the future. Ther Adv Chronic Dis.2020.11:2040622 320920106.
[12] Di Mussi R,Spadaro S,Stripoli T, et al. High-flow nasal cannula oxygen therapy decreases postextubation neuroventil atory drive and work of breathing in patients with chronic obstructive pulmonary disease.Crit Care.2018.22(1):180.
[13] Longhini F,Pisani L,Lungu R,et al.High-Flow Oxygen Thera py After Noninvasive Ventilation Interruption in Patients Recove ring From Hypercapnic Acute Respiratory Failure: A Physiological Crossover Trial. Crit Care Med.2019.47(6):e506-e511.
[14] Onodera Y,Akimoto R,Suzuki H,Okada M,Nakane M,Kawamae K. A high-flow nasal cannula system with relatively low flow effectively washes out CO(2) from the anatomical dead space in a sophisticated respiratory model made by a 3D printer. Intensive Care Med Exp.2018.6(1):7.
[15] Sun YH, Dai B, Peng Y, Tan W, Zhao HW. Factors affecting FiO(2) and PEEP during high-flow nasal cannula oxygen thera py: A bench study. Clin Respir J.2019.13(12):758-764.
[16] Hummel A,Empe K,Dörr M, Felix SB. De novo acute heart failure and acutely decompensated chronic heart failure. Dtsch Arztebl Int.2015.112(17): 298-310.
[17] Asano R, Mathai SC, Macdonald PS, et al. Oxygen use in chronic heart failure to relieve breathlessness: A systema tic review.Heart Fail Rev.2020.25(2):195-205.
[18] 陆静钰,丁雯,张丽萍.急、慢性心力衰竭患者氧疗管理的最佳证据总结[J].中国医药科学,2023,13(20):141-145.
[19] Truschel B,Polkey MI.Optimizing Tracheal Oxygen Tension and Diffusion Ratio When Choosing High-Flow Oxygen The rapy or CPAP for the Treatment of Hypoxemic Respiratory Fail ure:Insights from Ex Vivo Physiologic Modelling.J Clin Med. 2023.12(8):2878.
[20] Roca O,Pérez-Terán P,Masclans JR, et al. Patients with New York Heart Association class III heart failure may benefit with high flow nasal cannula supportive therapy: high flow nasal cannula in heart failure.J Crit Care.2013.28(5):741-6.
[21] Yu Y,Yao RQ,Zhang YF,et al.Is oxygen therapy benefic ial for normoxemic patients with acute heart failure? A prope nsity score matched study.Mil Med Res.2021.8(1):38.
[22] Rochwerg B, Granton D, Wang DX, et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and metaanalysis. Intensive Care Med.2019.45(5):563-572.
[23] 朱茜,江海娇,胡斌,等.成人患者低氧血症经鼻高流量氧疗进展[J].齐齐哈尔医学院学报,2023,44(13):1249-1252.
[24] Zhao H, Wang H,Sun F,Lyu S,An Y.High-flow nasal cann ula oxygen therapy is superior to conventional oxygen ther apy but not to noninvasive mechanical ventilation on intubat ion rate: a systematic review and meta-analysis. Crit Care. 2017,21(1): 184.
[25] Feng Z, Zhang L, Yu H, et al. High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation for AECOPD Patients After Extubation:A Systematic Review and Meta-Anal ysis of Randomized Controlled Trials. Int J Chron Obstruct Pul mon Dis.2022.17:1987-1999.
[26] 中国医师协会急诊医师分会,中华医学会急诊医学分会,中国急诊专科医联体,北京急诊医学学会.急诊成人经鼻高流量氧疗临床应用专家共识.中华急诊医学杂志,2021,30(9):1041-1050.
[27] Li XY,Tang X, Wang R,et al. High-Flow Nasal Cannula for Chronic Obstructive Pulmonary Disease with Acute Compensat ed Hypercapnic Respiratory Failure: A Randomized, Controlled Trial.Int J Chron Obstruct Pulmon Dis.2020.15:3051-3061.
[28] 陆广生.不同流速经鼻高流量氧疗治疗充血性心力衰竭患者的疗效比较[D].广州医科大学,2022.
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