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。
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 ow 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.
作者
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
HE Guojun;HAN Yijiao;FANG Qiang;ZHOU Jianying;SHEN Jifang;LI Tong;PU Qibin;CHEN Aijun;QI Zhiyang;SUN Lijun;CAI Hongliu(Department of Respiratory Therapy,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Intensive Care Unit,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Respiratory Medicine,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Infectious Diseases,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Emergency,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China)
出处
《浙江大学学报（医学版）》
CAS
CSCD
北大核心
2020年第2期232-239,共8页
Journal of Zhejiang University(Medical Sciences)
基金
浙江省重点研发计划应急攻关项目(2020C03123)。
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
Coronavirus disease 2019
Severe acute respiratory syndrome coronavirus 2
Novel coronavirus infection
Critical illness
High-flow nasal cannula oxygen therapy
Respiratory therapy
