经鼻高流量氧疗在患儿麻醉中的应用进展

Progress in the application of high flow nasal cannula oxygen therapy in pediatric anesthesia

经鼻高流量氧疗(HFNC)是一种无创的呼吸支持技术。在国外,HFNC作为持续气道正压通气系统(CPAP)的替代治疗方法,最早被应用于重症监护室的患儿中,以改善患儿肺部功能,治疗呼吸系统疾病。近年来HFNC逐渐被应用于患儿麻醉领域中。HFNC能够增加呼吸暂停时间,用于患儿麻醉围插管期,可以保证患儿的氧合,提高插管成功率。HFNC可以持续高流量供氧,且不占用患儿气道,在气道操作手术中应用时可以为术者提供充足的操作空间,同时缓解麻醉科医师在患儿缺氧时的紧张焦虑。HFNC可以提供持续的气道正压,应用于患儿麻醉围拔管期,能够有效地促进肺复张,预防和治疗拔管后肺部并发症。然而HFNC应用时有其自身的局限性,如何更充分有效地应用HFNC仍需大量临床随机对照研究来论证。

High flow nasal cannula(HFNC)oxygen therapy is a new noninvasive respiratory support technology.In foreign countries,HFNC was first applied to children in intensive care unit to improve their lung function and treat respiratory diseases as an alternative treatment of continuous positive airway pressure ventilation(CPAP).In recent years,HFNC has been gradually applied in the field of anesthesia for children.HFNC can be used during prei-intubation to increase the time of safe asphyxia,in order to ensure the oxygenation and improve the success rate of intubation in children.HFNC supplied continuous high flow oxygen without occupying the airway of children and provided sufficient operation space for the operator.Anesthesiologists could reduce the tension and anxiety during children s hypoxia.HFNC was used during peri-operative to promote lung recruitment,and prevent or treat pulmonary complications after extubation because of providing continuous positive airway pressure.However,the application of HFNC has its own limitations.How to fully and effectively apply HFNC still needs a large number of clinical randomized controlled trials to provide demonstration.