经鼻插管高流量氧疗在婴幼儿细支气管炎中的应用越发普遍,但其疗效尚缺少高质量的研究证据。根据新英格兰医学杂志刊载的研究结果,高流量氧疗对非ICU婴幼儿细支气管炎的治疗效果显著,可显著降低治疗失败率。

经鼻插管高流量氧疗是指通过无需密封的特制鼻导管直接经鼻输入加温湿化的混合氧气,可产生气道正压。经鼻插管高流量氧疗已经较广泛地应用于成人。其设备见下图。

经鼻插管高流量氧疗作用机制主要有以下几个方面:(1)经鼻插管高流量氧疗可以冲刷鼻咽部的死腔,有利于促进肺泡内气体交换,减少总体死腔,从而改善肺部的气体交换。(2)经鼻插管高流量氧疗将干冷气体温化湿化达人体最适温度湿度,增加肺部顺应性,并且维持呼吸道表面黏液纤毛系统的正常清除功能,减少呼吸道干燥,增加患者的舒适性和顺应性。(3)节省患者主动加温保湿的能量代谢。

朗读

High-flowoxygentherapythroughanasalcannulahasbeenincreasinglyusedininfantswithbronchiolitis,despitelimitedhigh-qualityevidenceofitsefficacy.

Nosignificantdifferenceswereobservedinthedurationofhospitalstayorthedurationofoxygentherapy.Ineachgroup,onecaseofpneumothoraxoccurred.

Amongtheinfantsinthestandard-therapygroupwhohadtreatmentfailure,(61%)hadaresponsetohigh-flowrescuetherapy.

延伸阅读

AmonginfantswithbronchiolitiswhoweretreatedoutsideanICU,thosewhoreceivedhigh-flowoxygentherapyhadsignificantlylowerratesofescalationofcareduetotreatmentfailurethanthoseinthegroupthatreceivedstandardoxygentherapy.

PositivePressureRespiratorySupportNoninvasivepositivepressurerespiratorysupportisusefulintreatingbothhypoxemicandhypoventilatoryrespiratoryfailure.Positiveairwaypressurehelpsaeratepartiallyatelectaticorfilledalveoli,preventalveolarcollapseatendexhalation,andincreasefunctionalresidualcapacity(FRC).Thisimprovespulmonary







































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