High-Flow Nasal Cannula, nthawi zambiri amafupikitsidwa ngati Mtengo wa HFNC, wakhala mwala wapangodya mu chisamaliro chamakono cha kupuma. Izi zatsopano mankhwala a nasal cannula imapereka gawo lalikulu kuchokera ku njira zachikhalidwe, kupereka chithandizo chowonjezereka kwa odwala omwe ali ndi zovuta zosiyanasiyana za kupuma. Ngati ndinu katswiri wazachipatala, woyang'anira zogula zinthu ngati Mark Thompson ku USA, kapena wina yemwe akuchita nawo zachipatala, kumvetsetsa Mtengo wa HFNC ndizofunikira. Nkhaniyi ikufuna kusokoneza mkulu otaya nasal cannula Thandizo, kuyang'ana njira zake, zopindulitsa, kagwiritsidwe ntchito, ndi zomwe muyenera kuziganizira pofufuza machitidwe ofunikirawa. Monga Allen, wochokera ku kampani yodziwika bwino pazamankhwala ku China, ndadzionera ndekha kufunikira kokulirapo komanso zotsatira zabwino zamakhalidwe abwino. Mtengo wa HFNC mankhwala. Tidzakambirana chifukwa chake izi mkulu otaya mphuno umisiri ndi zambiri kuposa njira ina; nthawi zambiri ndi chisankho chapamwamba chowongolera mpweya ndi chitonthozo choleza mtima, makamaka pazochitika za pachimake kupuma kulephera. Chidutswachi ndi choyenera nthawi yanu chifukwa chimaphwanya zidziwitso zovuta kuti zikhale zomveka bwino, zomwe zimatengera kumvetsetsa kwachipatala komanso momwe mungapangire, ndikukuthandizani kuti mupange zisankho zodziwikiratu zopulumutsa moyo. mankhwala okosijeni.
1. Kodi kwenikweni Thandizo la High-Flow Nasal Cannula (HFNC) ndi Chiyani Ndipo Limagwira Ntchito Bwanji?
High-Flow Nasal Cannula (HFNC) Thandizo ndi njira yapamwamba yothandizira kupuma yomwe imapereka a kuthamanga kwambiri kusakanikirana kwa mpweya/oxygen kwa wodwala, makamaka kudzera mwapadera mphuno kapena cannulae. Mosiyana ndi chikhalidwe otsika otaya mpweya wa m'mphuno machitidwe, Mtengo wa HFNC akhoza kupereka gasi pa mitengo yoyenda zomwe nthawi zambiri zimaposa za wodwala mayendedwe olimbikitsa zofuna. Ichi ndi kusiyana kwakukulu. Ganizirani izi motere: ngati wodwala akupuma mofulumira komanso mozama, cannula ya m'mphuno yokhazikika singapereke mpweya wokwanira kuti akwaniritse zosowa zawo, zomwe zimapangitsa kulowetsedwa kwa mpweya m'nyumba ndi zosayembekezereka pang'ono FIO2 (gawo la mpweya wouziridwa). Mtengo wa HFNC machitidwe, komabe, akhoza kupereka mitengo yoyenda mpaka malita 60 pamphindi kapena kupitilira apo kwa akulu, kuonetsetsa kuti mpweya umakhala wokhazikika komanso wodalirika.
The Mtengo wa HFNC dongosolo amakhala ndi zigawo zikuluzikulu zitatu: mpweya/oxygen blender kulamulira FIO2, chinyontho chotenthetsera kutentha ndi chepetsa mpweya, ndi dera lotenthetsera lomwe limapereka mpweya wokhazikika kwa wodwala kudzera pa a nasal cannula. Kukhoza chepetsa ndi kutentha mpweya n'kofunika kuti odwala chitonthozo ndi kulolerana, makamaka pa mitengo yothamanga kwambiri. Izi zimalepheretsa kuyanika kwa njira yapamlengalenga zilonda zam'mimba, zomwe zimatha kukhala zovuta kwambiri popanda matenda, mkulu otaya mphuno gasi. The kugwiritsa ntchito HFNC ikukula kwambiri m'malo osiyanasiyana, kuchokera ku dipatimenti yazadzidzidzi mpaka ku chisamaliro chachikulu unit (ICU), yoyang'anira odwala omwe ali ndi mitundu yosiyanasiyana ya kupuma movutikira. Ife, monga opanga, timayang'ana kwambiri pakupanga bwino komanso kothandiza nasal cannulae, monga wathu Kutaya PVC nasal mpweya cannula chubu kwa khanda ndi wamkulu, yopangidwa kuti ikwaniritse bwino kuperekedwa kwa izi Chithandizo cha HFNC.
Njira yeniyeni ya Mtengo wa HFNC kumaphatikizapo zambiri osati kungopereka zinthu zambiri kutuluka kwa oxygen. Zimathandiza kuchotsa nasopharyngeal danga lakufa, kuchepetsa ntchito ya kupuma, kupereka pang'ono zabwino kuthamanga kwa mpweya, ndikuwonetsetsa kuti pakhale bata FIO2. Kuphatikiza uku kumapanga Mtengo wa HFNC chida chamtengo wapatali cha mankhwala okosijeni, makamaka za odwala pachimake matenda kupuma. The mlingo wotuluka ndi FIO2 Zitha kulembedwa paokha, zomwe zimalola asing'anga kusintha chithandizocho kuti chigwirizane ndi zosowa za wodwala aliyense. Kutumiza kokhazikika kwa cholembedwa FIO2 ndi phindu lalikulu, monga limachepetsa kuchepetsedwa kwa oxygen kuchokera kumlengalenga.
2. Kodi HFNC Imasiyana Bwanji Ndi Njira Zochiritsira Oxygen?
Zachikhalidwe kapena mpweya wabwino Njira zothandizira, monga ma cannula a m'mphuno kapena masks osavuta amaso, nthawi zambiri amatulutsa mpweya wochepa mitengo yoyenda, nthawi zambiri mpaka malita 6 pa mphindi pa cannulas ndipo mwina 10-15 L/mphindi kwa masks. Ngakhale izi ndizothandiza pa hypoxemia yofatsa, zili ndi malire. Kusiyana kwakukulu kuli mu mlingo wotuluka yokha. Mtengo wa HFNC amapereka gasi pa mayendedwe opitilira nsonga ya wodwalayo mayendedwe othamanga, nthawi zambiri kuyambira 20 mpaka 60 L / min, kapena kupitirira apo. Izi zikutanthauza Mtengo wa HFNC dongosolo limapereka kwambiri, ngati si onse, gasi wowuziridwa ndi wodwala, zomwe zimapangitsa kuti pakhale kusasinthasintha komanso kuwonekeratu. FIO2. Ndi machitidwe ochiritsira, wodwalayo nthawi zambiri amapuma mpweya wochuluka wa chipinda pamodzi ndi mpweya wowonjezera, kusungunula mpweya woperekedwa ndikupanga chenichenicho. FIO2 zosinthika komanso zotsika kuposa momwe amafunira. Izi kulowetsedwa kwa mpweya m'nyumba ndi vuto lalikulu kuti Mtengo wa HFNC amachepetsa bwino.
Kusiyana kwina kofunikira ndikuyika kwa gasi wouziridwa. Mtengo wa HFNC machitidwe amapangidwa kuti azitentha ndi chepetsa mpweya kufupi ndi kutentha kwa thupi (pafupifupi 37 ° C) ndi 100% chinyezi wachibale. Izi ndizofunikira chifukwa kutulutsa mpweya wouma, wozizira mitengo yothamanga kwambiri akhoza kuwononga njira yapamlengalenga zilonda zam'mimba, zilonda zam'mimba, zilonda zam'mimba, zilonda zam'mimba, zilonda zam'mimba ntchito ya kupuma. Oxygen wamba machitidwe, makamaka okwera kwambiri kudzera mu masks, nthawi zambiri amapereka mpweya wozizira, wowuma, womwe ungathe kulekerera kwa nthawi yaitali. The kutentha ndi chinyezi gasi ku Mtengo wa HFNC chipangizo bwino chitonthozo odwala ndi kutsatira, zomwe n'zofunika kuti bwino mankhwala okosijeni. Izi zokha zimapangitsa Mtengo wa HFNC njira yabwino kwa ambiri odwala kupuma zovuta.
Komanso, Mtengo wa HFNC imapereka maubwino owonjezera amthupi omwe samawonedwa ndi machitidwe otsika. Izi zikuphatikizapo kusamba kwa nasopharyngeal danga lakufa la anatomical, yomwe imapangitsa kuti ntchitoyo ikhale yabwino mpweya wabwino, ndi kubadwa kwa mlingo wochepa wa zabwino kuthamanga kwa mpweya (PAP), yomwe ingathandize kulemba alveoli ndikuwongolera mpweya. Ngakhale osati m'malo mwa mpweya wabwino wosasokoneza (NIV) kapena mpweya wabwino nthawi zonse, Mtengo wa HFNC imatseka mpata, kupereka chithandizo chochulukirapo kuposa mpweya woyenda pang'ono koma kukhala wocheperako komanso wololera bwino kuposa masks a NIV. The kugwiritsa ntchito cannula yamphuno yothamanga kwambiri imayimira kupita patsogolo kwakukulu mu machitidwe operekera mpweya, kusuntha kupyola zowonjezera zowonjezera za okosijeni kupita ku chithandizo chogwira ntchito cha kupuma.
3. Kodi Ubwino Waikulu Wa Pathupi Pakugwiritsa Ntchito Mphuno Yothamanga Kwambiri Ndi Chiyani?
The kugwiritsa ntchito HFNC imabweretsa zabwino zingapo zofunika pathupi zomwe zimathandizira kuti zithandizire kuthana ndi vuto la kupuma. Chimodzi mwazofunikira kwambiri ndikuchepetsa kwa nasopharyngeal danga lakufa. Zopitilira kuthamanga kwambiri mpweya umatulutsa mpweya woipa (CO2) kuchokera kumtunda njira yapamlengalenga panthawi yopuma. Izi zikutanthauza kuti ndi mpweya uliwonse wotsatira, wodwalayo amakoka mpweya wokhala ndi mpweya wochepa wa CO2 ndi mpweya wambiri wa okosijeni, zomwe zimapangitsa mpweya wabwino bwino kwambiri. Kusamba uku danga lakufa la anatomical kungayambitse kuchepa kwa kupuma ndi zonse ntchito ya kupuma, chomwe chiri cholinga chachikulu pochiza odwala pachimake kupuma kulephera.
Chachiwiri, Mtengo wa HFNC akhoza kupanga pang'ono zabwino kuthamanga kwa mpweya (PAP). Ngakhale mulingo wa PAP umasinthasintha ndipo zimatengera mlingo wotuluka ndipo kaya pakamwa pa wodwalayo n’chotseguka kapena chotsekedwa, ngakhale kuwonjezereka kochepa kungakhale kopindulitsa. Kuthamanga uku kungathandize kuti stent kutsegula chapamwamba njira yapamlengalenga, kuchepetsa atelectasis (kugwa kwa mapapu), ndi kusintha mphamvu yomaliza yopuma m'mapapo. Izi zimathandiza kuti bwino mpweya ndipo zitha kukhala zothandiza makamaka kwa odwala omwe ali ndi vuto ngati pachimake hypoxemic kupuma kulephera. Kutumiza kokhazikika kwa FIO2 ku mitengo yothamanga kwambiri imatsimikiziranso kuti wodwalayo amalandira mpweya wokwanira, kuchepetsa kusinthasintha komwe kumachitika chifukwa cha kusintha kwa kupuma kapena kupuma. kulowetsedwa kwa mpweya m'nyumba.
Pomaliza, humidification yabwino yoperekedwa ndi Mtengo wa HFNC machitidwe sikuti amangotonthoza; ili ndi phindu lolunjika pazathupi kwa njira yapamlengalenga. Moyenera humidified mkulu otaya mpweya umathandizira kuti mucociliary escalator ikhale yogwira ntchito bwino, yomwe ndi yofunika kwambiri pochotsa zotuluka m'mapapo. Izi zitha kuletsa kusungidwa kwa zotupa, kuchepetsa chiopsezo cha matenda, ndikusunga njira yapamlengalenga patency. Kutentha ndi chinyezi kumalepheretsanso kuyanika ndi kupsa mtima kwa njira za m'mphuno ndi kutsika njira yapamlengalenga, zomwe zimapangitsa kulolerana bwino kwa odwala komanso kumamatira ku mankhwala okosijeni. Izi bwino kulolerana ndi chinthu chofunika kwambiri pa kupambana kwa Chithandizo cha HFNC, makamaka pamene chithandizo chautali chikufunika. Monga opanga, timamvetsetsa kufunikira kwa zopindulitsa izi, zomwe zimayendetsa kudzipereka kwathu kupanga zinthu zamtengo wapatali zogulira. Mtengo wa HFNC.
4. N'chifukwa Chiyani Kusungunuka Moyenera Ndikofunikira Kwambiri Pakuchiritsa Kwa M'mphuno Kwapamwamba?
Kunyowetsa koyenera sikungokhala "zabwino kukhala nazo" mkati mkulu otaya mphuno chithandizo; ndizofunikira kwambiri pachitetezo chake komanso kuchita bwino. Mukatumiza gasi pa a kuthamanga kwambiri, nenani malita 30 mpaka 60 pa mphindi, mwachindunji mu ndime za mphuno, ngati mpweyawo uli wozizira komanso wouma, ukhoza kuchotsa chinyezi ndi kutentha kuchokera ku njira yapamlengalenga mucosa. Izi zingayambitse mavuto ambiri: kutupa, kusokonezeka kwa ciliary (tsitsi laling'ono lomwe limasesa ntchofu ndi zinyalala m'mitsempha). njira yapamlengalenga), kutsekemera kochuluka, kutuluka kwa mamina, ndipo ngakhale kutuluka magazi. Odwala adzakhala ndi vuto lalikulu, monga kuuma kwa mphuno, kupweteka, ndi kutentha thupi, zomwe zimawapangitsa kuti azilephera kupirira. Chithandizo cha HFNC kwa nthawi yayitali. Choncho, mwayi chepetsa ndi kutentha mpweya bwino ndi mwala wapangodya wa Mtengo wa HFNC.
Mtengo wa HFNC makina amapangidwa kuti azipereka mpweya womwe umatenthedwa kufika pafupifupi 37 ° C (kutentha kwa thupi) komanso wodzaza ndi nthunzi wamadzi (pafupi ndi 100% chinyezi chapafupi). Izi zimatsanzira momwe mpweya umakhalira kumtunda njira yapamlengalenga. Popereka izi kutentha ndi chinyezi gasi, Mtengo wa HFNC amateteza njira yapamlengalenga epithelium, imasunga bwino mucociliary chilolezo, ndipo imathandizira kwambiri chitonthozo cha odwala komanso kulolerana. Izi zimathandiza odwala kulandira phindu lonse la kuthamanga kwambiri ndi kulembedwa FIO2 kwa nthawi yayitali, yomwe nthawi zambiri imakhala yofunika ngati pachimake kupuma kulephera. Chitonthozo chowonjezereka chimachepetsanso kusokonezeka kwa wodwalayo komanso ntchito ya kupuma, popeza sakulimbana ndi chisonkhezero chokwiyitsa.
Kuchokera pakupanga, kuonetsetsa kuti machitidwe a humidification ali Mtengo wa HFNC zipangizo ndi odalirika ndi zothandiza kwambiri. Izi zikuphatikiza mapangidwe a humidifier palokha, chubu chotenthetsera chomwe chimalepheretsa kukhazikika ("mvula-kutuluka") mudera, ndi mawonekedwe ( nasal cannulae). Kuchuluka kwa chinyezi kumatha kunyalanyaza zabwino zambiri Mtengo wa HFNC ndipo ngakhale kuvulaza. Muzochitika zanga pa Wopanga Zida Zachipatala - ZhongXing, timayika patsogolo zinthu ndi mapangidwe omwe amathandizira kukonza bwino kwa gasi. Kwa othandizira azaumoyo, ndikofunikira kuwonetsetsa kuti Mtengo wa HFNC dongosolo lakhazikitsidwa moyenera komanso kuti chipinda cha humidification chimadzazidwa ndikugwira ntchito bwino. Chisamaliro ichi mwatsatanetsatane chimapangitsa kusiyana kwakukulu pazotsatira za odwala komanso kupambana konse kwa mkulu otaya nasal cannula okosijeni mankhwala.
5. Kumvetsetsa Mayendedwe: Kodi Zimakhudza Bwanji HFNC Mwachangu?
The mlingo wotuluka mosakayikira ndi chikhalidwe chodziwika kwambiri Mtengo wa HFNC therapy ndipo imagwira ntchito mosiyanasiyana pakuchita bwino kwake. Chimodzi mwazokhudza zoyamba za a kuthamanga kwambiri ndi kuthekera kwake kukumana kapena kupitilira nsonga ya wodwalayo mayendedwe olimbikitsa zofuna. Mu wodwala ndi kupuma movutikira, wawo mayendedwe olimbikitsa akhoza kukhala okwera kwambiri (mwachitsanzo, 30-120 L / min). Ngati yaperekedwa mlingo wotuluka kuchokera ku chipangizo cha okosijeni ndi chocheperako kuposa ichi, wodwalayo mosakayikira adzakoka mumlengalenga, zomwe zimatsogolera kuchepetsedwa kwa oxygen ndi zosayembekezereka FIO2. Mtengo wa HFNC machitidwe, popereka mitengo yoyenda Nthawi zambiri mpaka 60 L/mphindi (ndipo nthawi zina apamwamba pazida zinazake), akhoza kuchepetsa mpweya m'chipinda chino, kuonetsetsa mokhazikika ndi modalirika kuperekedwa kwa analamula. FIO2. Izi ndizofunikira kuti zitheke mpweya.
Kupitilira kungokumana zolimbikitsa zofuna, ndi kuthamanga kwambiri imathandizira kuchotsedwa kwa nasopharynx danga lakufa. Mtsinje wopitilira wa gasi watsopano umatulutsa mpweya wochuluka wa CO2 kuchokera kumtunda njira yapamlengalenga (pharynx ndi mphuno). Kuchepetsa uku danga lakufa zikutanthauza kuti mpweya uliwonse uli ndi gawo lalikulu la mpweya wa okosijeni, zomwe zimapangitsa kuti alveolar igwire bwino ntchito mpweya wabwino ndi kuchepetsa mwayi kupuma ndi ntchito ya kupuma. The apamwamba ndi mlingo wotuluka, kawirikawiri, kuchapa kumeneku kumakhala kothandiza kwambiri, mpaka kufika pamlingo wina. Makinawa ndiwopindulitsa kwambiri odwala pachimake kupuma komwe kumasinthana bwino kwa gasi kumasokonekera.
Komanso, a mlingo wotuluka mu Mtengo wa HFNC amathandizira m'badwo wa zabwino kuthamanga kwa mpweya (PAP). Ngakhale kuti kupanikizika kumeneku kumakhala kochepa (nthawi zambiri 1-5 cmH2O) ndipo kumasiyana ndi kutuluka, thupi la wodwalayo, komanso ngati pakamwa ndi lotseguka kapena lotsekedwa, likhoza kukhala ndi zotsatira zopindulitsa. Izi zikuphatikizapo stenting kutsegula chapamwamba njira yapamlengalenga, kuwonjezeka mphamvu yomaliza yopuma m'mapapo, ndi kuthekera kolemba alveoli yomwe idagwa. Kusankha kwa mlingo wotuluka Choncho ndi chisankho chofunika kwambiri chachipatala, chomwe nthawi zambiri chimayamba pamlingo wochepetsetsa (mwachitsanzo, 30-40 L / min) ndi kutchulidwa kutengera yankho la wodwalayo, chitonthozo, mpweya status, ndi ntchito ya kupuma. Kusintha kwa mlingo wotuluka ndi dynamic ndondomeko mu kasamalidwe ka pachimake kupuma kulephera ndi Mtengo wa HFNC.
6. Kodi Thandizo la Oxygen la Cannula Oxygen-Flow-Flow High-Flow limalangizidwa liti kwa Odwala?
High-Flow Nasal Cannula (HFNC) oxygen therapy akulimbikitsidwa pakukula kwa matenda osiyanasiyana omwe odwala amafunikira thandizo la kupuma kuposa mpweya wabwino Thandizo lingapereke, koma silingafunebe, kapena lingathe kuchotsedwa, ku mitundu yowonjezereka ya chithandizo. Chizindikiro choyambirira ndi acute hypoxemic kupuma kulephera (AHRF). Izi ndizochitika wamba chisamaliro chachikulu malo omwe odwala amavutika kuti akhalebe okwanira mpweya ngakhale mpweya wabwino. HFNC yawonetsedwa kuwongolera mpweya, kuchepetsa kupuma, ndi kuchepetsa dyspnea mu izi odwala pachimake hypoxemic kupuma kulephera. Maphunziro ofalitsidwa m'magazini ngati Crit Care Med ndi Intensive Care Med adafufuza zotsatira za high-flow nasal cannula mu chiwerengero ichi, nthawi zambiri zabwino.
Malo ena ofunikira kugwiritsa ntchito HFNC ili mu nthawi ya post-extubation. Odwala omwe asiya kuyamwa kuchokera kumakina mpweya wabwino ali pa chiopsezo chachikulu wa decompensation wa kupuma. Mtengo wa HFNC Angagwiritsidwe ntchito ngati muyeso wa prophylactic kapena ngati chithandizo cha post-extubation kupuma movutikira. The zotsatira za postextubation mkulu-kutuluka m'mphuno chithandizo chafanizidwa ndi mpweya wamba komanso ngakhale mpweya wabwino wosasokoneza, ndi kafukufuku wina wosonyeza ubwino wopewa kulowetsanso m'thupi, makamaka m'magulu ena a odwala. Mwachitsanzo, a postextubation high-flow nasal cannula vs muyezo mpweya mkangano akupitiriza, koma Mtengo wa HFNC nthawi zambiri amapereka chitonthozo chabwinoko komanso chodalirika FIO2.
Kupitilira izi, Mtengo wa HFNC imagwiritsidwanso ntchito kwa odwala omwe ali ndi mitundu yocheperako ya pachimake kupuma kulephera, omwe ali ndi ma "do not intubate" (DNI) omwe amafunikira chithandizo chothandizira kupuma kuti chitonthozedwe, komanso muzochita zolimbitsa thupi kuti zisungidwe. mpweya. Ikupezanso gawo pazovuta zazikulu monga kuchulukira kwa COPD (ngakhale NIV nthawi zambiri imakhala mzere woyamba pano) komanso mwa odwala ana. Kusinthasintha kwa Mtengo wa HFNC, kugwiritsa ntchito kwake mosavuta, komanso kutonthoza mtima kwa odwala kumathandiza kuti ntchito zake zikule. Cholinga nthawi zonse ndi kupereka zokwanira mankhwala okosijeni ndi thandizo pamene kuchepetsa ntchito ya kupuma ndi kupewa kukwera ku njira zowononga ngati nkotheka. Kusankha kugwiritsa ntchito Chithandizo cha HFNC ziyenera kukhazikitsidwa nthawi zonse pakuwunika mosamala zachipatala za zosowa za wodwala aliyense komanso ma pathology.
7. Kodi HFNC Ingathandize Kuchepetsa Kufunika Kwa Mpweya Wosautsa Wamakina?
Ili ndi funso lofunika kwambiri komanso gawo lalikulu la kafukufuku komanso chidwi chachipatala. Kuthekera kwa Mtengo wa HFNC kuchepetsa kufunika kwa invasive mechanical ventilation (IMV), ndi zovuta zake monga chibayo chokhudzana ndi mpweya, ndi chimodzi mwazinthu zochititsa chidwi kwambiri. Kwa odwala ena, makamaka omwe ali ndi pachimake hypoxemic kupuma kulephera, umboni umasonyeza zimenezo Mtengo wa HFNC akhoza kuchepetsa mlingo wa intubation poyerekezera ndi mankhwala wamba wa okosijeni ndipo, nthawi zina, ngakhale mpweya wabwino wosasokoneza (NIV). Luso la Mtengo wa HFNC kupereka khola FIO2, kuchepetsa danga lakufa, perekani PEEP, ndi kuchepetsa ntchito ya kupuma zonse zimathandizira ku kuthekera uku.
Mayesero akuluakulu angapo azachipatala afufuza ntchito ya Mtengo wa HFNC popewa intubation. Ngakhale zotsatira zimatha kusiyanasiyana malinga ndi gulu la odwala komanso kuuma kwawo pachimake kupuma kulephera, kafukufuku wambiri wasonyeza khalidwe labwino. Mwachitsanzo, mu odwala pachimake hypoxemic kupuma mikhalidwe, kuyambitsa koyambirira kwa Mtengo wa HFNC Zitha kuwakhazika mtima pansi ndikuletsa kuwonongeka kwina komwe kungafunikire intubation. Ndikofunika kuzindikira zimenezo Mtengo wa HFNC si panacea; ngati wodwala kupuma kumalephera kuyenda bwino kapena awo mpweya akupitirizabe kuipiraipira ngakhale zili bwino Chithandizo cha HFNC, ndiye kuti kukwera ku IMV kungakhale kofunikira. Mtengo wa HFNC amapereka chithandizo chothandizira, kugula nthawi kuti mankhwala ena ayambe kugwira ntchito kapena kuti vutolo lithe.
Komabe, kupambana kwa Mtengo wa HFNC popewa intubation imadalira kusankha koyenera kwa odwala komanso kuyang'anira mosamala. Sikoyenera kwa odwala omwe ali ndi vuto lalikulu la kupuma kwa hypercapnic (komwe NIV ingakhale yabwinoko) kapena omwe akuwonongeka mofulumira kapena osatha kuteteza. njira yapamlengalenga. Koma kwa ambiri odwala ndi kupuma kulepheramakamaka amtundu wa hypoxemic, Mtengo wa HFNC imapereka mwayi wofunikira, wosasokoneza. Mwa kuwongolera mpweya ndi kuchepetsa kupsinjika kwa thupi la kupuma, Chithandizo cha HFNC zingathandize odwala kupewa zoopsa ndi zovuta za intubation. Izi zimapangitsa kukhala chida chofunikira kwambiri pamasewera kasamalidwe ka pachimake kupuma kulephera mu chisamaliro chachikulu kukhazikitsa ndi kupitirira.
8. Kodi Ubwino Wotani wa HFNC M'makonzedwe Osiyanasiyana a Zachipatala ndi Pakutumiza Oxygen?
Mtengo wa HFNC imapereka maubwino angapo omwe athandizira kuti atengeke m'malo osiyanasiyana azachipatala, kuyambira zipinda zadzidzidzi kupita ku mawodi wamba ndi chisamaliro chachikulu mayunitsi. Chimodzi mwazofunikira kwambiri ndikuwongolera chitonthozo cha odwala ndi kulolerana poyerekeza ndi njira zina zothandizira kupuma, makamaka mpweya wabwino wosasokoneza (NIV) masks. Masks a NIV amatha kukhala olimba, kuyambitsa zilonda zamaso, ndikupangitsa kuti zikhale zovuta kwa odwala kudya, kumwa, kapena kulankhulana. Mtengo wa HFNC, yoperekedwa kudzera mwa soft mphuno, nthawi zambiri amalekerera bwino. Chitonthozo chokongoletsedwachi chingapangitse kutsata bwino mankhwala okosijeni, zomwe ndi zofunika kuti apambane. Odwala amatha kulankhula, kudya, ndi kumwa mosavuta pamene akulandira Mtengo wa HFNC, kupititsa patsogolo chidziwitso chawo chonse ndi mgwirizano ndi chithandizo.
Ubwino wina wothandiza ndi kuphweka kwa kagwiritsidwe ntchito ndi kasamalidwe kake poyerekeza ndi makina opangira mpweya. Pamene Mtengo wa HFNC machitidwe ndi ovuta zida zoyenda, nthawi zambiri zimakhala zosavuta kukhazikitsa ndi kuyang'anira ogwira ntchito za unamwino. Ma interfaces ndi ovuta kwambiri, komanso amasinthasintha mlingo wotuluka ndi FIO2 ndi zowongoka. Kugwiritsa ntchito mosavuta kumeneku kungakhale kopindulitsa makamaka m'malo otanganidwa azachipatala kapena m'malo omwe ogwira ntchito sangakhale ndi maphunziro apadera okhudza kupuma. Komanso, chifukwa Mtengo wa HFNC amapereka mosasinthasintha ndi odalirika kachigawo kakang'ono ka okosijeni wowuziridwa, imathandizira kutumiza kwa oxygen ndi kuyang'anira. Madokotala amatha kukhala otsimikiza kuti wodwalayo akulandira mlingo wokwanira wa okosijeni, kuchepetsa kusatsimikizika komwe kumakhudzana ndi kuchepetsedwa kwa oxygen kuwoneka ndi machitidwe ochiritsira.
Kusinthasintha kwa Mtengo wa HFNC imawonjezeranso ubwino wake. Itha kugwiritsidwa ntchito kwa odwala osiyanasiyana, kuyambira odwala akuluakulu ndi ana kwa omwe ali ndi zovuta zosiyanasiyana kupuma movutikira. Imakhala ngati mlatho wabwino kwambiri pakati pa okosijeni woyenda pang'ono ndi machiritso owononga kwambiri. Mwachitsanzo, itha kugwiritsidwa ntchito kwa odwala omwe sakudwala mokwanira NIV kapena intubation koma amafunikira chithandizo chochulukirapo kuposa muyezo. nasal cannula akhoza kupereka. kusinthasintha uku kumapanga Mtengo wa HFNC chigawo chofunika kwambiri cha njira yothandizira kupuma. The kuchepa kwa ntchito ya kupuma ndi bwino mpweya limapereka kungayambitse kukhalitsa m'chipatala kwaufupi komanso zotsatira zabwino kusamalira odwala, kupanga mkulu otaya nasal cannula wothandizira mankhwala njira yabwino komanso yothandiza.
9. Kuchokera Pansi Pa Factory Yathu: Kuonetsetsa Ubwino wa Nasal Cannulae wa HFNC
Monga Allen, woyimira fakitale yokhala ndi mizere isanu ndi iwiri yopangira ku China, ndikuuzeni kuti kupanga zinthu zachipatala, makamaka zomwe zimagwiritsidwa ntchito movutikira monga. Mtengo wa HFNC, amafuna kudzipereka kosasunthika ku khalidwe. Zikafika nasal cannulae makamaka zopangidwira mkulu otaya nasal cannula chithandizo, zinthu zingapo ndizofunikira. Zipangizozi ziyenera kukhala zachipatala, zogwirizana ndi biocompatible, komanso zofewa kuti zitsimikizire chitonthozo cha odwala, makamaka popeza izi mphuno amalumikizana mwachindunji ndi mucosa wamphuno kwa nthawi yayitali. Timayang'ana kwambiri kupanga zida ngati zathu Wosabala Mphuno Oxygen Cannula Neonatal 2mm Grade II Medical ndi malingaliro awa patsogolo. Mapangidwe a ma prong nawonso ndi ofunikira - amayenera kukwanira bwino komanso mosatekeseka popanda kuyambitsa kupanikizika kosayenera, pomwe amalola kuti agwire bwino ntchito. kutumiza kwa oxygen ku mitengo yothamanga kwambiri.
Umphumphu wa zonse Mtengo wa HFNC kuzungulira, kuphatikiza machubu ndi zolumikizira, ndikofunikira. Iyenera kukhala yokhoza kuthana ndi kutentha, humidified mkulu otaya mpweya wopanda kutsika, kutayikira, kapena kuchititsa condensation kwambiri. Kusabereka, komwe kumafunika (ngakhale zambiri Mtengo wa HFNC malo olumikizirana ndi odwala ndi oyera osati osabala, kutengera dongosolo ndi ndondomeko zam'deralo), ndi chinthu china chosakambitsirana. Njira zathu zopangira zinthu zimatsatira mfundo zokhwima zapadziko lonse lapansi monga ISO 13485, ndipo zogulitsa zathu nthawi zambiri zimakhala ndi chizindikiritso cha CE, zomwe ndizizindikiro zazikulu zaubwino ndi kutsata zomwe oyang'anira zogula ngati Mark Thompson amafunafuna. Ife tikumvetsa izo odwala pachimake kupuma, kudalirika kwa gawo lililonse lawo Chithandizo cha HFNC ndizofunikira.
Komanso, kusasinthasintha pakupanga ndikofunikira. Gulu lililonse la nasal cannulae kapena zina Mtengo wa HFNC zigawo ziyenera kukumana ndi miyezo yapamwamba yofanana. Izi zimaphatikizapo kuwunika mozama zaubwino wazinthu pamagawo angapo opanga, kuyambira pakuwunika kwazinthu zopangira mpaka kuyesa komaliza. Timayika ndalama muukadaulo wotsogola wopanga komanso kuphunzitsa antchito kuonetsetsa kuti aliyense Mtengo wa HFNC mankhwala kusiya malo athu, kaya ndi yosavuta nasal cannula kapena chigawo chovuta kwambiri cha mankhwala okosijeni komanso mpweya wabwino wosasokoneza mosalekeza, imagwira ntchito momwe ikuyembekezeredwa. Kudzipereka ku khalidweli ndi momwe timapangira chidaliro ndi makasitomala athu a B2B - zipatala, zipatala, ndi ogulitsa mankhwala padziko lonse lapansi omwe amadalira ife kuti tikhale otetezeka komanso ogwira mtima. mpweya wothamanga kwambiri machitidwe operekera. Kuyang'ana pazabwinoku kumafikira pagulu lathu lonse, kuphatikiza Medical Suction Kulumikiza Tube 1.8mm Ndi Yankuer, kuwonetsetsa kugwira ntchito modalirika pazamankhwala athu onse.
10. Mfundo zazikuluzikulu za Kugula: Kupeza Njira Zodalirika za HFNC ndi Zopereka
Kwa oyang'anira zogula ngati Mark Thompson ku USA, kapena aliyense amene ali ndi udindo wofufuza Mtengo wa HFNC machitidwe ndi zinthu zomwe zimagwiritsidwa ntchito m'zipatala, zipatala, kapena mabungwe azachipatala, zinthu zingapo zofunika zimabwera. Choyamba, mosakayika, ndi chitsimikizo chaubwino ndi kutsata malamulo. Muyenera kuonetsetsa kuti Mtengo wa HFNC zipangizo ndi zigawo zake, makamaka nasal cannulae ndi mabwalo, amakwaniritsa miyezo yokhwima yachipatala. Yang'anani ziphaso monga ISO 13485, chizindikiro cha CE, ndi chilolezo cha FDA ngati kuli koyenera. Monga opanga, timamvetsetsa zofunikira izi ndikuwonetsetsa kuti zinthu zathu, monga zathu Mtengo wa HFNC-zogwirizana mpweya wa m'mphuno cannulas, kukumana ndi zizindikiro zapadziko lonse lapansi. Kutsimikizira ziphasozi mwachindunji ndi wopanga kapena kudzera pamacheke odziwika bwino a chipani chachitatu ndi gawo lofunikira.
Chachiwiri, ganizirani za machitidwe ndi mawonekedwe cha Mtengo wa HFNC dongosolo. Kodi amapereka osiyanasiyana mitengo yoyenda ndi zolondola FIO2 kulamulira? Kodi humidification dongosolo bwino ndi odalirika mu luso lake chepetsa gasi? Nanga bwanji za mawonekedwe a odwala - pali kukula kwake kosiyanasiyana mphuno kupezeka kuti agwirizane ndi odwala osiyanasiyana, kuchokera odwala akuluakulu ndi ana? Kugwiritsa ntchito bwino kwa ogwira ntchito zachipatala ndikofunikiranso - ndikosavuta bwanji chida choyenda kukhazikitsa, kugwira ntchito, ndi kuyeretsa? Zinthu izi zimakhudza mwachindunji mphamvu ya Chithandizo cha HFNC ndi kuchuluka kwa ntchito kwa othandizira azaumoyo. The max flow kuthekera, kulondola kwa kuchuluka kwa gasi kutumiza, ndi kuthekera kwa dongosolo kusunga kuthamanga kwa mpweya ndi mbali zonse zaukadaulo zomwe ziyenera kufufuzidwa.
Pomaliza, kudalirika kwa ogulitsa ndi chithandizo ndi zofunika. Mufunika ogulitsa omwe angatsimikizire kuti pali chain yokhazikika, makamaka pazinthu zomwe zimatha kutaya Mtengo wa HFNC dongosolo. Kodi nthawi yawo yotsogolera ndi yotani? Kodi mbiri yawo yobweretsera pa nthawi yake ndi yotani? Kupitilira mayendedwe, lingalirani zothandizidwa pambuyo pakugulitsa, zophunzitsira, ndi chitsimikizo choperekedwa. Kuchita ndi wopanga kapena wofalitsa wodalirika yemwe amamvetsetsa zovuta za mankhwala okosijeni ndi mankhwala kwa pachimake kupuma kulephera imatha kuletsa mutu wambiri. Mtengo nthawi zonse umakhala wofunikira, koma uyenera kukhala wolingana ndi mtundu, kudalirika, komanso mtengo wonse Mtengo wa HFNC dongosolo limabweretsa chisamaliro cha odwala. Mwachitsanzo, mtengo pang'ono koma odalirika kwambiri mkulu otaya nasal cannula zomwe zimasintha zotsatira za odwala ndikuchepetsa chiopsezo cha zovuta kapena zovuta mlingo wa intubation imapereka mtengo wabwinoko wanthawi yayitali. Kupanga ubale wolimba ndi ogulitsa omwe amawonekera poyera pakupanga kwawo ndi njira zabwino za Mtengo wa HFNC ndi zokhudzana machitidwe operekera mpweya ndi key kwa odwala kwambiri med ndi kusamala madipatimenti.
Mfundo Zofunika Kwambiri pa Kuchiza kwa Nasal Cannula (HFNC):
- HFNC imapereka kuthamanga kwakukulu kwa kutenthedwa ndi kusakanikirana kwa mpweya / okosijeni, kupitirira zofuna zolimbikitsa odwala za FIO2 yokhazikika.
- Njira zazikuluzikulu zimaphatikizapo kutsuka kwa nasopharyngeal malo akufa, kutulutsa mpweya wabwino wapamsewu, komanso kutumiza kosasintha kwa FIO2.
- Mulingo woyenera humidification ndikofunikira kwa chitonthozo cha odwala, thanzi la ndege, ndi kulolerana kwa HFNC.
- Kuthamanga kumakhudza kukhazikika kwa FIO2, kuchotsedwa kwa malo akufa, ndi ntchito yopuma.
- HFNC imasonyezedwa pachimake hypoxemic kupuma kulephera, chithandizo cha post-extubation, ndi zina zomwe zimafuna chithandizo chowonjezera cha okosijeni.
- Zingathe kuchepetsa kufunika kokhala ndi mpweya wabwino mwa odwala osankhidwa bwino omwe akulephera kupuma movutikira.
- Ubwino wothandiza ndi kutonthoza odwala, kumasuka kugwiritsa ntchito, komanso kusinthasintha m'malo osiyanasiyana azachipatala.
- Kupanga kwapamwamba kwa zigawo za HFNC, makamaka cannulae zamphuno, ndikofunikira pofuna chitetezo ndi mphamvu, zomwe zimafuna kutsata miyezo yachipatala.
- Kugula kuyenera kuyang'ana pazabwino, kutsata malamulo, magwiridwe antchito, komanso kudalirika kwa ogulitsa pofufuza machitidwe a HFNC.
Kufufuza uku kwa Mtengo wa HFNC imasonyeza ntchito yake yofunika kwambiri pa chithandizo chamakono cha kupuma. Monga opanga, ife ku ZhongXing timanyadira kupereka nawo gawoli popereka zida zapamwamba zachipatala zomwe zimathandizira mkulu otaya nasal cannula chithandizo, kuthandiza kuwongolera mpweya ndi zotsatira za odwala padziko lonse lapansi.
Nthawi yotumiza: May-20-2025