经鼻高流量氧疗应用于2019冠状病毒病(COVID-19)重型患者的临床经验

doi:10.3785/j.issn.1008-9292.2020.03.13

浙江大学学报（医学版）

2020, Vol. 49

Issue (2): 232-239 DOI: 10.3785/j.issn.1008-9292.2020.03.13

原著

经鼻高流量氧疗应用于2019冠状病毒病(COVID-19)重型患者的临床经验

何国军¹(

),韩一骄¹,方强^2,*(

),周建英³,盛吉芳⁴,李彤⁵,浦其斌¹,陈爱君¹,戚志洋¹,孙丽君¹,蔡洪流^2,*(

)

1. 浙江大学医学院附属第一医院呼吸治疗科, 浙江杭州 310003
2. 浙江大学医学院附属第一医院重症医学科, 浙江杭州 310003
3. 浙江大学医学院附属第一医院呼吸内科, 浙江杭州 310003
4. 浙江大学医学院附属第一医院感染科, 浙江杭州 310003
5. 浙江大学医学院附属第一医院急诊科, 浙江杭州 310003

Clinical experience of high-flow nasal cannula oxygen therapy in severe COVID-19 patients

HE Guojun¹(

),HAN Yijiao¹,FANG Qiang^2,*(

),ZHOU Jianying³,SHEN Jifang⁴,LI Tong⁵,PU Qibin¹,CHEN Aijun¹,QI Zhiyang¹,SUN Lijun¹,CAI Hongliu^2,*(

)

1. Department of Respiratory Therapy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
2. Intensive Care Unit, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
3. Department of Respiratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
4. Department of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
5. Department of Emergency, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China

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摘要：

2019冠状病毒病（COVID-19）患者以急性Ⅰ型呼吸功能衰竭为突出表现。合理有效的呼吸支持是此类患者最重要的器官支持手段。经鼻高流量氧疗（HFNC）较其他无创呼吸支持手段具有更大优势。COVID-19重型患者氧合水平波动大、病情进展迅速，HFNC应用时机宜早，老年患者不宜长期使用。早期使用时需要做好患者教育，提高依从性；使用中注意选择合适型号的鼻塞导管，注意鼻塞导管是否在位并及时评估鼻腔和上呼吸道通畅。存在排痰风险或呼吸窘迫症状明显的患者建议初始即给予最高水平的支持（37 ℃的湿化温度、60 L/min的流量），或可先给予低水平的参数并逐步上调；无慢性呼吸系统疾病患者氧合目标可维持95%以上以降低频繁的低氧、缺氧风险。治疗过程中采用适当措施减少飞沫和气溶胶传播风险，并采取必要的医院感染防控措施。

关键词： 2019冠状病毒病; 严重急性呼吸综合征冠状病毒2; 新型冠状病毒感染; 危重病; 经鼻高流量氧疗; 呼吸治疗

Abstract:

Acute respiratory failure due to acute hypoxemia is the major manifestation in severe coronavirus disease 2019 (COVID-19). Rational and effective respiratory support is crucial in the management of COVID-19 patients. High-flow nasal cannula (HFNC) has been utilized widely due to its superiority over other non-invasive respiratory support techniques. To avoid HFNC failure and intubation delay, the key issues are proper patients, timely application and improving compliance. It should be noted that elder patients are vulnerable for failed HFNC. We applied HFNC for oxygen therapy in severe and critical ill COVID-19 patients and summarized the following experiences. Firstly, to select the proper size of nasal catheter, to locate it at suitable place, and to confirm the nose and the upper respiratory airway unobstructed. Secondly, an initial flow of 60 L/min and 37℃ should be given immediately for patients with obvious respiratory distress or weak cough ability; otherwise, low-level support should be given first and the level gradually increased. Thirdly, to avoid hypoxia or hypoxemia, the treatment goal of HFNC should be maintained the oxygen saturation (SpO₂) above 95% for patients without chronic pulmonary disease. Finally, patients should wear a surgical mask during HFNC treatment to reduce the risk of virus transmission through droplets or aerosols.

Key words: Coronavirus disease 2019 Severe acute respiratory syndrome coronavirus 2 Novel coronavirus infection Critical illness High-flow nasal cannula oxygen therapy Respiratory therapy

收稿日期: 2020-03-06 出版日期: 2020-04-03

R68

基金资助: 浙江省重点研发计划应急攻关项目(2020C03123)

通讯作者: 方强,蔡洪流 E-mail: rcpchina@zju.edu.cn;1183005@zju.edu.cn;1193001@zju.edu.cn

作者简介: 何国军(1981-), 男, 硕士研究生, 主管技师, 主要从事呼吸治疗技术相关研究; E-mail:rcpchina@zju.edu.cn; https://orcid.org/0000-0001-7151-1121

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引用本文:

何国军,韩一骄,方强,周建英,盛吉芳,李彤,浦其斌,陈爱君,戚志洋,孙丽君,蔡洪流. 经鼻高流量氧疗应用于2019冠状病毒病(COVID-19)重型患者的临床经验[J]. 浙江大学学报（医学版）, 2020, 49(2): 232-239.

HE Guojun,HAN Yijiao,FANG Qiang,ZHOU Jianying,SHEN Jifang,LI Tong,PU Qibin,CHEN Aijun,QI Zhiyang,SUN Lijun,CAI Hongliu. Clinical experience of high-flow nasal cannula oxygen therapy in severe COVID-19 patients. J Zhejiang Univ (Med Sci), 2020, 49(2): 232-239.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2020.03.13 或 http://www.zjujournals.com/med/CN/Y2020/V49/I2/232

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