高流量鼻腔氧化,而不是通风:是时候停止屏住呼吸了
George A Wen1, Michael F Aziz2
1Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA.
British journal of anaesthesia
|December 16, 2025
概括
高流量鼻氧化 (HFNO) 在手术期间有效地保持氧气,但不会去除二氧化碳,风险高. 考虑多式监控和通风辅助器,以更安全地使用无呼吸HFNO.
科学领域:
- 麻醉学 麻醉学
- 呼吸系统医学 呼吸系统医学
- 关键的护理关键的护理
背景情况:
- 高流鼻氧化 (HFNO) 越来越多地用于无管上呼吸道手术,用于在呼吸暂停期间的氧化.
- 早期的研究表明潜在的通风效益,导致诸如"THRIVE"之类的术语.
研究的目的:
- 批判性地评估有关HFNO通风能力的证据.
- 为临床实践中HFNO使用提出实际考虑,强调CO2管理.
主要方法:
- 系统审查和综合目前关于HFNO的证据.
- 既定指导方针与新兴研究成果的整合.
- 对成人和儿童不同流速的二氧化碳积累数据的分析.
主要成果:
- 累积的证据表明,HFNO不能有效地清除二氧化碳 (CO2).
- 在一系列的流速中观察到一致的二氧化碳积累,构成高头症的风险.
- 头过高对血液动力学和神经功能有重大影响,特别是在高风险患者中.
结论:
- 术语"透鼻加湿快速吸气通风交换 (THRIVE) "应被"无呼吸高流鼻氧化 (无呼吸HFNO) "所取代.
- 应强调在无呼吸HFNO期间进行多式二氧化碳监测.
- 建议在必要时选择性使用通风辅助器来控制二氧化碳水平.
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