經鼻高流量氧氣治療原理與臨床應用

Nasal High Flow Oxygen Therapy and Clinical Application of the Principle

賈德蓉(Te-Jung Chia) ； 譚美珠(Mei-Chu Tan) ； 李昭賢(Chao-Hsien Lee) ； 龍芳(Fang Jung)

《呼吸治療》 13卷1期 (2014/01) Pp. 25-36

https://doi.org/10.6269/JRT.2014.13.1.03

摘要

氧氣治療是臨床常見的呼吸治療策略之一，在實務操作上分為低流量與高流量氧氣系統，而低流量氧氣無法提供穩定的氧氣濃度，高流量氧氣則會有濕度供應不足的限制。經鼻高流量（Nasal High Flow；NHF）氧氣治療經由大孔徑鼻導管（wide-bore nasal can nula）提供每分鐘最高60升的流量，37℃相對溼度100%加溫加濕的氣體。目前新生兒使用經鼻高流量氧氣治療已經廣泛使用於小兒及新生兒呼吸照護，但使用於成人氧氣治療則是最近幾年才受到重視。目前成人經鼻高流量氧氣治療的研究顯著增加，其功能也有多方面的證實，其中包括經鼻高流量氧氣治療可以提供有效率的氧氣與濕度的輸送，提高病人使用意願，以及急性照護上的安全性和有效性，並超越傳統的氧氣濃度不穩定與濕度供應不足的限制，臨床上不僅是肺部疾病、心臟手術後、缺氧性呼吸衰竭，甚至痰液排除困難病人都是可能的受惠對象。

關鍵字

經鼻高流量氧氣 ； 呼吸道衛生 ； 持續性呼吸道正壓

並列摘要

Oxygen therapy is a common clinical respiratory therapeutic method. In clinical practice, the inspired oxygen concentration cannot be reliably determined from the low flow system and high flow system delivers oxygen with inadequate humidification. Nasal high flow (NHF) oxygen therapy via wide-bore nasal cannula provides the maximum flow rate of 60 L/min and warm (37°C) humidified (100% relative humidity) oxygenated gas. Currently, NHF oxygen therapy for newborns has gained increasing acceptance in the treatment of respiratory conditions. It is being widely used in pediatric and neonatal respiratory care, but NHF oxygen therapy in adults has just recently drawn attention. A number of studies on NHF oxygen therapy confirmed the efficiency and safety in adults recently. The mechanism of high flow oxygen administration by NHF include reduction of nasopharyngeal dead space, improvement of pulmonary distending pressure, increased inspiratory reserve volume, decreased inspiratory resistance and reducing work of breathing. NHF oxygen therapy is safe and efficient means to offer stable inspired oxygen concentrations with adequate humidity levels, therefore the patient compliance can be drastically improved. Clinical studies have shown NHF oxygen therapy to be beneficial for patients with lung disease, post-cardiac surgery, hypoxic respiratory failure, and mucus hypersecretion with retention. This article aims to review the evidence for the use of NHF oxygen therapy in adults.

並列關鍵字

nasal high flow (NHF) oxygen therapy ； airway management ； continuous positive airway pressure (CPAP)

參考文獻

Shoemaker MT, Pierce MR, Yoder BA, et al. High flow nasal cannula versus nasal CPAP for neonatal respiratory disease: a retrospective study. J Perinatol 2007; 27:85-91.

L'Her E, Deye N, Lellouche F, et al. Physiologic effects of noninvasive ventilation during acute lung injury. Am J Respir Crit Care Med. 2005; 172:1112-1118.

Ricard JD, Boyer A. Humidification during oxygen therapy and non-invasive ventilation: do we need some and how much? Intensive Care Med 2009; 35:963-965.

Williams R, Rankin N, Smith T, et al. Relationship between the humidity and temperature of inspired gas and the function of the airway mucosa. Crit Care Med. 1996; 4:1920-1929.

Jhung MA, Sunenshine RH, Noble-Wang, et al. A national outbreak of Ralstonia mannitolilytica associated with use of a contaminated oxygen-delivery device among pediatric patients. Pediatrics. 2007; 119: 1061- 1068.