麻醉中使用高流量鼻吸氧技术维持氧合的研究进展  

Research progress on the use of high-flow nasal oxygen therapy for maintaining oxygenation during anesthesia

作　　者：曲世界 白殊同(综述)[2] 陈艳(审校)[1] QU Shijie;BAI Shutong;CHEN Yan(Department of Anesthesiology,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China;Basic Research Laboratory,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China)

机构地区：[1]重庆市中医院麻醉科,重庆400021 [2]重庆市中医院基础研究室,重庆400021

出　　处：《检验医学与临床》2025年第4期552-555,562,共5页Laboratory Medicine and Clinic

基　　金：重庆市科卫联合医学科研项目(2024MSXM134)。

摘　　要：高流量鼻吸氧(HFNO)技术(以下简称HFNO)是通过不需要密封的鼻塞导管,直接将一定浓度的氧气混合高流量气体输送给患者的一种氧疗方式,因其维持患者窒息氧合效果良好且简便易行,已在临床麻醉中受到广泛关注。该文从麻醉科临床实际应用的角度出发,对HFNO在麻醉科气道管理中的应用场景,包括涉及呼吸道的外科手术中窒息氧合、困难气道及清醒插管、拔管和术后支持、深度镇静中的呼吸支持和全身麻醉快速诱导中的相关研究进行文献综述,以方便同行了解该技术的应用场景和使用特点。当前,HFNO在麻醉科使用场景下的深度开发和应用与临床需求仍存在较大差距,需要大量随机对照试验数据对该技术的短期和长期患者获益情况进行评价,但HFNO具备设置简单、患者接受度高、能够产生气道正压和高浓度的吸入氧气、冲洗鼻咽无效腔,并在一定程度上清除二氧化碳的特点。同时,HFNO通过鼻插管的方式为能够自主呼吸的患者提供呼吸支持,为呼吸暂停患者提供窒息氧合,减少肺不张,并且HFNO具有可支持面罩通气、喉镜气管插管操作和呼吸道外科手术,并能够为患者提供稳定可靠的氧合等诸多优势,随着HFNO的进步,在解决其局限性之后,必将拓展其临床应用范围,造福患者。High-flow nasal oxygen therapy(HFNO)is a method of oxygen therapy that delivers oxygen mixed with high-flow gas directly to patients through a non-sealing nasal cannula,which does not require a sealed connection.Due to its advantages of maintaining adequate oxygenation in patients with respiratory distress and being simple to use,it has attracted significant attention in clinical anesthesia practice.This paper reviews the application scenarios of HFNO in airway management from the perspective of clinical anesthesia practice.It discusses its use in apneic oxygenation during airway surgeries,management of difficult airways and awake intubation,extubation and postoperative support,respiratory support during deep sedation and rapid induction of general anesthesia.The review aims to provide colleagues with a better understanding of the application scenarios and characteristics of this technique.Currently,there is still a significant gap between the in-depth development and application of HFNO in anesthesiology and clinical needs.Extensive randomized controlled trial data are needed to evaluate the short-term and long-term benefits of this technology for patients.However,HFNO offers advantages such as simple setup,high patient acceptance,the ability to generate positive airway pressure,deliver high concentrations of inhaled oxygen,wash out ineffective spaces in the nasopharynx,and remove carbon dioxide to a certain extent.Meanwhile,HFNO provides respiratory support for spontaneously breathing patients through nasal cannulas,asphyxia oxygenation for apnea patients,and helps reduce atelectasis.Moreover,HFNO supports mask ventilation,laryngoscopic tracheal intubation procedures and airway surgeries while offering stable and reliable oxygenation for patients.With continuous advancements in HFNO and overcoming its limitations,its clinical applications will undoubtedly expand,benefiting more patients.

关 键 词：高流量鼻吸氧 麻醉 呼吸 窒息氧合 困难气道 

分 类 号：R614.2[医药卫生—麻醉学] R459.6[医药卫生—外科学]