I-High-Flow Nasal Cannula, evame ukufushaniswa njenge HFNC, sekuyitshe legumbi ekunakekelweni kokuphefumula kwanamuhla. Lokhu okusha Ukwelashwa kwe-cannal kwe-nasal Inikeza isinyathelo esibalulekile kusuka ezindleleni zendabuko, ukuhlinzeka ngokusekelwa okuthuthukile kweziguli ezinezinselelo ezahlukahlukene zokuphefumula. Uma uchwepheshe wezokunakekelwa kwempilo, umphathi wezokuthengwa kwempahla njengoMark Thompson e-USA, noma othile obandakanyeka ekutholeni usizo lwezokwelapha, ukuqonda HFNC kubalulekile. Lo mbhalo uhlose ukudiliza I-High Flow Nasal Cannula Ukwelapha, ukuhlola izindlela zalo, izinzuzo, izinhlelo zokusebenza, nokuthi yini okufanele uyicabangele lapho sithola lezi zinhlelo ezibalulekile. Njengoba u-Allen, kusuka enkampanini egxile ekudleni kwezokwelapha eChina, ngizibonele mathupha isidingo esikhulayo kanye nomthelela omuhle wekhwalithi HFNC imikhiqizo. Sizokwenza ukuthi kungani lokhu Ukugeleza okuphezulu kwe-Nasal Ubuchwepheshe bungaphezu nje kwenye indlela; Imvamisa kuyindlela ephakeme yokuthuthuka umoya-mpilo kanye nenduduzo yesineke, ikakhulukazi ezimweni ze Ukwehluleka kokuphefumula kwe-acute. Lesi siqeshana sisifanele isikhathi sakho ngoba sidiliza imininingwane eyinkimbinkimbi yokugayeka kokugaya ukudla, ukudweba kusuka ekuqondeni kwemitholampilo kanye nasekuhlolweni kokukhiqiza, kukusiza ekugcineni izinqumo ezinolwazi mayelana nalokhu kulungiswa kwempilo Therapy we-oksijini.
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I-High-Flow Nasal Cannula (HFNC) Ukwelashwa kuyindlela eyinkimbinkimbi yokuxhaswa okuphefumula okunikezela a ukugeleza okuphezulu ye-air / oxygen inhlanganisela esigulini, ngokuvamile ngokukhethekile Ama-prongs we-nasal noma i-cancculae. Ngokungafani nokugeleza okuphansi kwendabuko umoya-mpilo we-nasal izinhlelo, HFNC ingahambisa igesi at Amanani wokugeleza lokho kuvame ukwedlula isiguli okwakho ukugeleza okukhuthazayo Izidingo. Lokhu kungukuhlukaniswa okubalulekile. Cabanga ngalokhu: Uma isiguli siphefumula ngokushesha nangokujulile, i-cannal cannal ejwayelekile kungenzeka inganikeze umoya-mpilo owanele ukufeza izidingo zabo, okuholele kukho Ukungena komoya wekamelo futhi kungabikezelwa okuncane Fio2 (Ingxenyana ye-oxygen ephefumulelwe). HFNC Amasistimu, noma kunjalo, angakwazi ukuletha Amanani wokugeleza Kufika kumalitha angama-60 ngomzuzu noma ngaphezulu kwabantu abadala, ukuqinisekisa ukunikezwa komoya-mpilo okungaguquki nokuthembekile.
Le khasi HFNC uhlelo ngokuvamile luqukethe izingxenye ezintathu eziphambili: i-air / oxygen blender ukulawula i Fio2, umswakama wokufudumala futhi -nesihawu igesi, kanye nomjikelezo ovuthayo owethula igesi enesimo esiya esigulini nge I-Nasal Cannula. Amandla okwenza -nesihawu futhi ukushisa igesi kubalulekile ekududuzeni ngesineke nokubekezelelana, ikakhulukazi at Amanani aphezulu okugeleza. Le nqubo ivimbela ukomiswa kwe njengoba I-Mucosa, engaba yinkinga ebalulekile ngokungenamqondo, Ukugeleza okuphezulu kwe-Nasal igesi. Le khasi Ukusetshenziswa kwe-HFNC kuya ngokuya kuvame kakhulu kumasethingi ahlukahlukene, kusuka emnyangweni wezimo eziphuthumayo kuya ku ukunakekelwa okujulile iyunithi (ICU), ukuphatha iziguli ngezinhlobo ezahlukahlukene ze ukuhlupheka okuphefumulayo. Thina, njengabakhiqizi, gxila ekwakheni okunethezekile futhi okusebenzayo I-Nasal Canlulae, Njengethu Ukulahlwa kwe-PVC NASAL OXYGEN Cnula Tube yengane nomuntu omdala, yakhelwe ukwenza ngcono ukulethwa kwalokhu I-HFNC Therapy.
Indlela eqondile ye HFNC kubandakanya okungaphezu kokumane ahambise okuphezulu ukugeleza komoya-mpilo. Kuyasiza ngokugeza i-nasopharyngeal Isikhala Esifile, ukunciphisa umsebenzi wokuphefumula, ukuhlinzeka ngenani elincane elihle Ingcindezi ye-Airway, kanye nokuqinisekisa ukuzinza Fio2. Le nhlanganisela yenza HFNC ithuluzi elibalulekile le Therapy we-oksijini, ikakhulukazi for Iziguli ezinesibi Izinkinga zokuphefumula. Le khasi Izinga Lokugeleza na- Fio2 ingathunyelwa ngokuzimela, ukuvumela odokotela ukuthi basebenzise ukwelashwa ngezidingo zeziguli ngazinye. Ukulethwa okungaguquki kwemininingwane ebekiwe Fio2 inzuzo enkulu, njengoba inciphisa I-Oxygen Dilution kusuka emoyeni wekamelo.
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Ngokwendabuko noma umoya-mpilo ojwayelekile Izinhlelo zokwelapha, njenge-cannulal ejwayelekile yama-nasal noma imaski yobuso elula, ngokujwayelekile ukuletha umoya-mpilo phansi Amanani wokugeleza, Imvamisa kuze kube kufinyelela ku-6 amalitha ngomzuzu nge-Connulas futhi mhlawumbe 10-15 l / min amaski. Ngenkathi lezi zisebenza nge-hypoxemia emnene, zinokulinganiselwa. Umehluko oyinhloko ukhona ku Izinga Lokugeleza uqobo. HFNC Ihambisa igesi e Amanani wokugeleza adlula inani lesiguli Izinga lokugeleza elikhuthazayo, imvamisa isukela ku-20 kuye ku-60 l / min, noma ngaphezulu. Lokhu kusho HFNC Isistimu ihlinzeka kakhulu, uma kungenjalo konke, kwegesi ephefumulelwe yesiguli, okuholela ekuguqukeni nasekubikezelweni Fio2. Ngezinhlelo ezijwayelekile, isiguli sivame ukuphefumula ngenani elikhulu lekamelo umoya kanye nomoya-mpilo owengeziwe, ukunciphisa umoya-mpilo owethulwe nokwenza okwangempela Fio2 okuguqukayo futhi kuvame ukwedlula okuhlosiwe. Leli Ukungena komoya wekamelo kuyinselelo enkulu lokho HFNC i-mitigates ngempumelelo.
Omunye umehluko obalulekile yisimo segesi ephefumlelwe. HFNC izinhlelo zenzelwe ukushisa futhi -nesihawu igesi emazingeni okushisa omzimba (cishe ama-37 ° C) kanye nomswakama ohlobene no-100%. Lokhu kubalulekile ngoba ukuletha igesi eyomile, ebandayo e Amanani aphezulu okugeleza kungalimaza njengoba mucosa, dala ukungaphatheki kahle, ukuncipha kokuvunyelwa kwe-mucociliary, futhi kwandise Umsebenzi wokuphefumula. Umoya-mpilo ojwayelekile Amasistimu, ikakhulukazi ekuhambeni okuphezulu ngokusebenzisa imaski, kuvame ukuletha umoya-mpilo opholile, owomile, ongabekezelelwa kabi ngezikhathi ezengeziwe. Le khasi Kufudumele futhi kunomswakama igesi kusuka ku HFNC Idivayisi ithuthukisa induduzo yesiguli nokuhambisana, okubalulekile ukuze kuphumelele Therapy we-oksijini. Lesi sici sodwa siyakwenza HFNC inketho oyithandayo kwabaningi Iziguli ezinokuphefumula Izinselelo.
Ngaphezu kwalokho, HFNC Inikeza ezinye izinzuzo ezengeziwe zomzimba ezingabonakali zibonakala ngezinhlelo eziphansi zokugeleza. Lokhu kufaka phakathi ukugeza kwe-nasopharyngeal Isikhala esifile se-anatomical, okuthuthukisa ukusebenza kahle kwe ukupholisa, nesizukulwane sezinga elithile elihle Ingcindezi ye-Airway (I-PAP), engasiza ukuqasha i-alveoli futhi ithuthukise umoya-mpilo. Yize kungeyona into yokubuyiselwa umoya omncane wokuvusa (NIV) noma umoya wokuzihlanya kuzo zonke izimo, HFNC Broldges igebe, enikeza ukwesekwa okwengeziwe kunokuhamba nge-oksijini ephansi kodwa ube yinkimbinkimbi futhi ngokuvamile kubekezelelwa kangcono kunama-masks we-NIV. Le khasi Ukusetshenziswa kwe-High-Flow Nasal Cannula imelela intuthuko ebalulekile ku Izinhlelo ze-oksijini zokulethwa, Ukuhamba ngaphesheya kwesilula okungeziwe komoya-mpilo ku-Active Respiratory Support.
3. Yiziphi izinzuzo ezibalulekile zomzimba zokusebenzisa i-High-Flow Nasal Cannula?
Le khasi Ukusetshenziswa kwe-HFNC Iletha izinzuzo ezimbalwa ezibalulekile zomzimba ezifaka isandla ekusebenzeni kwayo ekuphatheni usizi lokuphefumula. Olunye olubaluleke kakhulu ukuncishiswa kwe-nasopharyngeal Isikhala Esifile. Okuqhubekayo ukugeleza okuphezulu yegesi ephumelele i-carbon dioxide (CO2) kusuka phezulu njengoba ngesikhathi sokuphefumula. Lokhu kusho ukuthi ngokuphefumula ngakunye okulandelayo, isiguli sihlala igesi nge-co2 ephansi ye-CO2 kanye nokuhlushwa okuphezulu komoya-mpilo, okwenzayo ukupholisa Isebenza kahle. Lokhu kugeza kwe Isikhala esifile se-anatomical kungaholela ekwehlisweni ku isilinganiso sokuphefumula kanye neyonke Umsebenzi wokuphefumula, okuwumgomo oyinhloko ekwelapheni Iziguli ezinokwehluleka kokuphefumula okukhulu.
Okwesibili, HFNC ingakhiqiza inani elincane elihle Ingcindezi ye-Airway (PAP). Ngenkathi izinga le-PAP lihluka futhi lincike ku- Izinga Lokugeleza nokuthi umlomo wesiguli uvulekile noma uvaliwe, ngisho nokwanda okunesizotha kungaba usizo. Le ngcindezi ingasiza ekuvuleleni okuphezulu njengoba, ukunciphisa i-atelectasis (i-lung collapse), futhi uthuthuke Ivolumu ye-End-Eviratoratory Lux. Lo mphumela unesandla kokungcono umoya-mpilo futhi ingasiza ikakhulukazi ezigulini ezinezimo ezinjengale Ukwehluleka kokuphefumula okuphezulu kwe-hypoxemic. Ukulethwa okungaguquki kwe Fio2 e- Amanani aphezulu okugeleza futhi iqinisekisa ukuthi isiguli sithola ukugxila kwe-oksijini okuhloswe ngayo, ukunciphisa ukuguquguquka okubangelwa ushintsho kuphethini lokuphefumula noma Ukungena komoya wekamelo.
Ekugcineni, umswakama omuhle kakhulu onikezwe ngu HFNC Izinhlelo akuyona nje induduzo; Inezinzuzo eziqondile zomzimba ze njengoba. Ngokufanelekile ukugeleza okuphezulu okuphezulu Igesi isiza ukugcina umsebenzi ojwayelekile we-mucociliary escalator, okubaluleke kakhulu ekuhlanzeni ukusulwa kwamaphaphu. Lokhu kungavimbela ukugcinwa kokugcinwa, ukunciphisa ingozi yokutheleleka, nokugcina njengoba ukubhebhetheka. Imfudumalo nomswakama nayo ivimbela ukomisa nokucasulwa kwezindinyana zamakhala futhi ziphansi njengoba, okuholela ekubekezelelekeni okungcono kwesiguli kanye nokunamathela ku Therapy we-oksijini. Lokhu kubekezelelwa ngcono kuyisici esibalulekile empumelelweni ye I-HFNC Therapy, ikakhulukazi lapho ukusekelwa isikhathi eside kudingeka. Njengomenzi, siyakuqonda ukubaluleka kwalezi zinzuzo, ezishayela ukuzibophezela kwethu ekukhiqizeni okuqukethwe okuphezulu kwe HFNC.
4. Kungani kungukunikezwa okuphezulu komswakama kubaluleke kakhulu ekwelashweni kwamakhala okuphezulu?
Umswakama ofanele awusona nje isici esithi "esihle-To -'-'-'E-WE Ukugeleza okuphezulu kwe-Nasal ukwelashwa; Kubalulekile impela ekuphepheni nasekusebenzeni kahle. Lapho uletha igesi at a Izinga eliphakeme lokugeleza, yisho amalitha angama-30 kuye kwangama-60 ngomzuzu, ngqo ezindimeni zamakhala, uma lelo gesi libanda futhi lomile, lingasheshisa ngokushesha umswakama nokushisa okuvela ku njengoba mucosa. Lokhu kungaholela ezinkingeni eziningi: ukuvuvukala, umsebenzi wobuciko obuthakathaka (izinwele ezincane ezikhukhuleka ama-mucus nemfucumfucu ngaphandle njengoba), amabhulukwe agqinsiwe, ama-mucus plugging, kanye nokopha. Iziguli zizothola ukungakhululeki okukhulu, njengokusoma kwamakhala, izinhlungu, kanye nomuzwa ovuthayo, kubenza bangathandeki ukuba babekezelele I-HFNC Therapy isikhathi eside. Ngakho-ke, amandla okwenza -nesihawu futhi ushise igesi ngempumelelo yi-Correrstone ye HFNC.
HFNC Amasistimu enzelwe ukuletha igesi efudunyezwa cishe ku-37 ° C Lokhu kulingisa isimo semvelo somoya esenzeka ngaphezulu njengoba. Ngokunikeza lokhu Kufudumele futhi kunomswakama igesi, HFNC kuvikela njengoba I-Epithelium, igcina i-mucocilier Createrance ejwayelekile, futhi ithuthukisa kakhulu induduzo yesiguli nokubekezelelana. Lokhu kuvumela iziguli ukuthola izinzuzo ezigcwele ze Izinga eliphakeme lokugeleza futhi kunqunyelwe Fio2 Ngezinkathi ezengeziwe, ezivame ukudingeka ezimweni ezinjengale Ukwehluleka kokuphefumula kwe-acute. Induduzo ethuthukisiwe nayo yehlisa ukuguga kwesiguli futhi Umsebenzi wokuphefumula, njengoba bengalwa nokukhuthaza okucasulayo.
Kusuka endaweni yokukhiqiza, ukuqinisekisa ukuthi izinhlelo zokunikezwa umswakama ngaphakathi HFNC Amadivayisi athembekile futhi asebenzayo ahamba phambili. Lokhu kufaka phakathi ukwakheka kwe-admishifier uqobo, ishubhu elifudumele elivimbela ukuvuselelwa ("imvula") esifundeni, kanye ne-interface (the I-Nasal Canlulae). Umswakama ompofu unganciphisa izinzuzo eziningi ze HFNC futhi kubangele ukulimala. Ngolwazi lwami ku- Umenzi wedivaysi ochwepheshe - i-zhongxing, Sibeka phambili izinto zokwakha nemiklamo esekela isimo esifanelekile segesi. Kwabahlinzeki bezokunakekelwa kwempilo, kubalulekile ukuqinisekisa ukuthi HFNC Uhlelo lusethwa kahle nokuthi igumbi lomswakama ligcwele futhi lisebenza kahle. Lokhu ukunaka imininingwane kwenza umehluko omkhulu emiphumeleni yeziguli kanye nempumelelo ephelele ye Ukugeleza okuphezulu kwe-cannuo oxygen yokwelashwa.
5. Ukuqonda Ukugeleza Kwezinga: Kuthinta Kanjani Ukusebenza Ngempumelelo kwe-HFNC?
Le khasi Izinga Lokugeleza kungokwezimpikiswano ezichazayo kakhulu ze HFNC Ukwelapha futhi udlala indima ehlukahlukene ekusebenzeni kwayo. Enye yemithelela yokuqala ye Izinga eliphakeme lokugeleza amandla ayo okuhlangana noma ukwedlula inani lesiguli ukugeleza okukhuthazayo Izidingo. Esigulini esine ukuhlupheka okuphefumulayo, yabo ukugeleza okukhuthazayo ingaba phezulu kakhulu (e.g., 30-120 l / min). Uma okulethwa Izinga Lokugeleza kusuka kudivayisi ye-oxygen kungaphansi kwalokhu, isiguli sizodonsa ngokungenakuphikwa emoyeni, okuholele kukho I-Oxygen Dilution kanye nokungalindelekile Fio2. HFNC amasistimu, ngokuhlinzeka Amanani wokugeleza Imvamisa kuze kube ngu-60 l / min (futhi kwesinye isikhathi ngaphezulu kwamadivayisi athile), inganciphisa lo msebenzi womoya, uqinisekise ukulethwa okuzinzile futhi okuthembekile kokubekiwe Fio2. Lokhu kubalulekile ukuze kusebenze umoya-mpilo.
Ngaphandle komhlangano nje okukhuthazo funa, the Izinga eliphakeme lokugeleza Inikela ekuhlanzeni kwe-nasopharyngeal Isikhala Esifile. Ukusakazwa okuqhubekayo kwegesi entsha kudonsela igesi ecebile ye-CO2 kusuka phezulu njengoba (Pharynx kanye ne-nasal cavity). Lokhu kuncishiswa ngaphakathi Isikhala Esifile kusho ukuthi umoya ngamunye uqukethe ingxenye ephakeme yegesi e-oxygedged, ethuthukisa ukusebenza kahle kwe-alveOlar ukupholisa futhi kungenzeka ukunciphisa isilinganiso sokuphefumula na- Umsebenzi wokuphefumula. Phezulu Izinga Lokugeleza, ngokuvamile, lokhu kugeza okusebenza ngempumelelo, kuze kube sephuzwini elithile. Le ndlela izuzisa ikakhulukazi Iziguli ezinesibi Izimo zokuphefumula lapho ukushintshana kwegesi okusebenzayo kwehlehliswa.
Ngaphezu kwalokho, The Izinga Lokugeleza phakathi kwa- HFNC kunomthelela esizukulwaneni sakho Ingcindezi ye-Airway (PAP). Ngenkathi le ngcindezi inesizotha (ngokujwayelekile 1-5 cmh2o) futhi iyahlukahluka ngokugeleza, isiguli anatomy, nokuthi umlomo uvulekile noma uvaliwe, usengaba nemiphumela ezuzisayo. Lokhu kufaka phakathi i-Stenting Vula phezulu njengoba, kukhula Ivolumu ye-End-Eviratoratory Lux, futhi kungenzeka ukuthi ukuqashwa kabusha kwawa alveoli. Ukukhethwa kwe Izinga Lokugeleza Ngakho-ke, kuyisinqumo esibalulekile somtholampilo, sivame ukuqalwa ezingeni eliphakathi (e.g., 30-40 l / min) futhi kubhalwe phansi ngokususelwa ekuphenduleni kwesiguli, induduzo, umoya-mpilo Isimo, futhi Umsebenzi wokuphefumula. Ukulungisa i- Izinga Lokugeleza inqubo enamandla ku ukuphathwa kokwehluleka kokuphefumula okukhulu ne- HFNC.
I-6. I-Over-Flow-Flow Cannal Cannal OULLGENY I-OULLZWE Ngokuvamile Kunconyelwa Iziguli?
I-Oxygen ye-Oxygen ye-Oxygen ephezulu kunconyelwa uhla olukhulayo lwezimo zemitholampilo lapho iziguli zidinga ukwesekwa okuphezulu kokuphefumula kunoku umoya-mpilo ojwayelekile Ukwelashwa kungahlinzeka, kepha kungenzeka kungabi nasidingo, noma kungalunyulwa, izindlela zokusekelwa ezihlaselayo. Inkomba eyinhloko yikhona Ukwehluleka ukuphefumula kwe-acute hypoxemic (AHRF). Lesi yisimo esivamile ngaphakathi ukunakekelwa okujulile Izilungiselelo lapho iziguli zilwela ukuze zilondoloze zanele umoya-mpilo naphezu komoya-mpilo ojwayelekile. I-HFNC ikhonjisiwe ukuthuthuka umoya-mpilo, ukunciphisa isilinganiso sokuphefumula, futhi idambise i-dyspnea kulezi Iziguli ezinokwehluleka kokuphefumula okuqinisayo kwe-hypoxemic. Izifundo ezishicilelwe kumaphephabhuku afana Ukunakekelwa Kokugxekwa na- Ukunakekelwa Okubanzi Med bahlole Umphumela we-High-Flow Nasal Cannula Kulesi sizwe, kaningi.
Enye indawo esemqoka ye Ukusetshenziswa kwe-HFNC isesikhathini sokukhuphuka ngemuva. Iziguli eziye zalunyulwa kusuka kumoya omncane ziseduze ingozi enkulu kokuwohloka kokuphefumula. HFNC ingasetshenziswa njengesilinganiso se-prophylactic noma njengendlela yokwelashwa kwe-post-extubane ukuhlupheka okuphefumulayo. Le khasi umphumela we-postexcation high-flow nasal Ukusekelwa kuqhathaniswe ne-oksijini ejwayelekile ngisho umoya omncane wokuvusa, Ngezinye izifundo eziphakamisa izinzuzo zokuvimbela ukuphindaphindeka, ikakhulukazi emaqenjini athile eziguli. Ngokwesibonelo, I-Possextubation High-Flow Nasal Cannula Vs Ingxoxo mpikiswano ejwayelekile yomoya-mpilo iyaqhubeka, kepha HFNC kuvame ukuhlinzeka ngenduduzo engcono futhi ethembeke kakhudlwana Fio2.
Ngale kwalokhu, HFNC kusetshenziselwa futhi iziguli ezinobunzima bezinhlobo ze Ukwehluleka kokuphefumula kwe-acute, lawo ane-oda "awenzi" ama-intabate "(DNI) adinga ukusekelwa kokuphefumula okuthuthukisiwe kwenduduzo, nasekuhlelweni kwenqubo ukuze kugcinwe umoya-mpilo. Kuthola nendima ezimweni ezingamanga olungamahlalakhona njenge-COPD EXTACERBARIONS (yize i-NIV ivame ukugcwaliseka lapha) nasezigulini zezingane. Ukuguquguquka kwe- HFNC, Ukusebenziseka kalula kwayo, kanye nenduduzo yesineke ineqhaza kwizicelo zayo ezandayo. Inhloso ihlala ihlinzeka ngokwanele Therapy we-oksijini nokuxhaswa ngenkathi kunciphisa Umsebenzi wokuphefumula nokugwema ukukhubazeka ezindleleni ezihlaselayo uma kungenzeka. Ukukhetha okufanele ukukusebenzisa I-HFNC Therapy Kufanele ngaso sonke isikhathi kususelwa ekuhlolweni ngokucophelela kwemitholampilo yezidingo zesiguli ngazinye kanye ne-pathology engaphansi.
7. I-HFNC ingasiza ukunciphisa isidingo somoya omncane wokuhlaselwa?
Lo ngumbuzo obucayi kanye nendawo ebalulekile yocwaningo kanye nentshisekelo yomtholampilo. Amandla e HFNC Ukuze sinciphise isidingo se-mechage umoya omncane (IMV), kanye nezinkinga zayo ezihambisanayo njenge-pneumonia ehlobene ne-ventiated, kungenye yamathemba awo akhangayo kakhulu. Kubantu abathile beziguli, ikakhulukazi labo abanayo Ukwehluleka kokuphefumula okuphezulu kwe-hypoxemic, ubufakazi bukhombisa lokho HFNC ingancipha ngempela Izinga lokuqonda Uma kuqhathaniswa nokwelashwa okujwayelekile komoya-mpilo futhi, kwezinye izikhathi, noma kunjalo umoya omncane wokuvusa (NIV). Ikhono le HFNC ukuhlinzeka ngezinzile Fio2, ukunciphisa Isikhala Esifile, nikeza ikhefu, futhi wehlise Umsebenzi wokuphefumula Bonke banikela kulokhu kungenzeka.
Izilingo eziningi ezinkulu zemitholampilo ziye zaphenya iqhaza le HFNC ekuvikeleni i-butshetion. Ngenkathi imiphumela ingahluka ngokuya ngeqembu elithile lesiguli kanye nobunzima babo Ukwehluleka kokuphefumula kwe-acute, izifundo eziningi zikhombise inkambiso emihle. Ngokwesibonelo, ku Iziguli ezinokuphefumula kwe-Hypoxemic izimo, ukuqalwa kokuqala kwe HFNC angaziqinisa futhi avikele ukuwohloka okuqhubekayo okungadinga ukuguga. Kubalulekile ukuqaphela lokho HFNC akuyona i-panacea; Uma isiguli Isilinganiso sokuphefumula sehluleka ukuthuthuka noma abo umoya-mpilo iyaqhubeka ikhulisa yize iphelele I-HFNC Therapy, khona-ke ukwanda ku-IMV kungadingeka. HFNC ihlinzeka Ukwesekwa Kwezokwelapha, isikhathi sokuthenga kwezinye izindlela zokwelapha okufanele zisebenze noma ngesimo esingaphansi kokuzixazulula.
Kodwa-ke, impumelelo ye HFNC ekugwemeni ukunqamula kokufundela ekukhetheni kweziguli ezifanele nokubhekisisa okusondelene. Akufaneleki ezigulini ezinokwehluleka okukhulu kwe-hypercapnic ukuphefumula (lapho i-NIV ingaba ngcono) noma labo awohloka ngokushesha noma abakwazi ukuvikela abo njengoba. Kepha kwabaningi Iziguli ezinokwehluleka kokuphefumula, ikakhulukazi uhlobo lwe-hypoxemic, HFNC Inikeza inketho ebalulekile, engahlaseli. Ngokwenza ngcono umoya-mpilo kanye nokunciphisa ukucindezelwa komzimba kokuphefumula, I-HFNC Therapy kungasiza iziguli ukuthi zigweme izingozi nokungaphatheki kahle kokuqonda. Lokhu kwenza kube yithuluzi elibalulekile ku ukuphathwa kokwehluleka kokuphefumula okukhulu ku ukunakekelwa okujulile ukubeka nangaphezulu.
8. Yiziphi izinzuzo ezingokoqobo ze-HFNC ezilungiselelweni ezahlukahlukene zemitholampilo kanye nokulethwa komoya-mpilo?
HFNC inikeza izinzuzo ezimbalwa ezisebenzayo ezifake isandla kokwamukelwa kwayo okubanzi ezindaweni ezahlukahlukene zemitholampilo, kusuka emakamelweni aphuthumayo kuya kumawadi ajwayelekile futhi ukunakekelwa okujulile amayunithi. Enye yezinto ezibaluleke kakhulu ukuthuthuka kweziguli nokubekezelelana ngokuqhathaniswa nezinye izindlela zokusekelwa kokuphefumula, ikakhulukazi umoya omncane wokuvusa (NIV) imaski. Imaski ye-NIV ingaqina, ibangele izilonda zobuso, futhi yenze kube nzima ezigulini zokudla, ukuphuza, noma ukuxhumana. HFNC, kuhanjiswa nge-soft Ama-prongs we-nasal, ngokuvamile kuyabekezelelwa kangcono. Le nduduzo ethuthukisiwe ingaholela ekutholeni kangcono Therapy we-oksijini, okubalulekile ukuze uphumelele. Iziguli zingakhuluma, zidle, ziphuze kalula ngenkathi zithola HFNC, ethuthukisa isipiliyoni sabo sonke nokubambisana nokwelashwa.
Enye inzuzo engokoqobo ukulula kohlelo lokusebenza kanye nokuphathwa kwayo uma kuqhathaniswa nama-ventical ndic. Lapho HFNC izinhlelo ziyinkimbinkimbi Amadivayisi wokugeleza, ngokuvamile kulula ukusetha nokuphatha abasebenzi abahlengikazi. Izindawo zokuxhumana ziyinkimbinkimbi, futhi zithambekele Izinga Lokugeleza na- Fio2 iqondile. Lokhu kulula kokusebenzisa kungazuzisa ikakhulukazi kumasethingi asemitholampilo noma ezindaweni lapho abasebenzi kungenzeka bangabi nokuqeqeshwa kokwelashwa okukhethekile. Ngaphezu kwalokho, ngoba HFNC ihlinzeka ngokungaguquguquki futhi okuthembekile ingxenyenamba ye-oxygen ephefumulelwe, kwenza lula Ukulethwa komoya-mpilo nokuqapha. Odokotela bangaqiniseka ngokwengeziwe ukuthi isiguli sithola izinga le-oxygen elinqunyelwe, linciphisa ukungaqiniseki okuhambisana nalo I-Oxygen Dilution kubonwe nezinhlelo ezivamile.
Ukuguquguquka kwe- HFNC futhi unezela ezinhlekeleleni zayo ezisebenzayo. Ingasetshenziselwa ukwahlulwa okuhlukahlukene kweziguli, kusuka Iziguli zabantu abadala nezingane kulabo abanezinto ezihlukile ze ukuhlupheka okuphefumulayo. Kusebenza njengebhuloho elihle kakhulu phakathi komoya-mpilo ophansi ophansi kanye nokwelapha okuhlaselayo. Isibonelo, ingasetshenziselwa iziguli ezingaguli kahle ngokwanele i-NIV noma i-Intubation kepha zidinga ukwesekwa okwengeziwe kune-Standard I-Nasal Cannula inganikeza. Lokhu kuguquguquka kwenza HFNC Ingxenye ebalulekile yendlela evuthayo ekusekelweni kokuphefumula. Le khasi kwehlise umsebenzi wokuphefumula futhi kwathuthukiswa umoya-mpilo Kuhlinzekela kungaholela ekuqhubekeni kwesibhedlela okufushane kanye nemiphumela engcono ye ukunakekela iziguli, Ukwenza I-High Flow Nasal Cannula Ukwelashwa Okusekelayo Inketho ephumelelayo nesebenzayo.
9. Ukusuka efektri yethu: Ukuqinisekisa ikhwalithi ku-cancumula ye-nasal ye-HFNC
Njengoba u-Allen, emele ifektri enezithelo eziyisikhombisa zokukhiqiza eChina, ngingakutshela ukuthi ukukhiqiza okuqukethwe kwezokwelapha, ikakhulukazi lezo zokusebenza ezibucayi ezifana HFNC, ifuna ukuzibophezela okungafanele kwekhwalithi. Uma kukhulunywa I-Nasal Canlulae yenzelwe ngqo I-High Flow Nasal Cannula Ukwelashwa, izinto eziningana zibaluleke kakhulu. Izinto zokwakha kumele zibe ibanga lezokwelashwa, i-biofempaniting, futhi ithambe ukuqinisekisa induduzo yesineke, ikakhulukazi kusukela la Ama-prongs we-nasal bathintana ngqo ne-mucosa ebucayi ye-nasal yezikhathi ezengeziwe. Sigxile ekukhiqizeni amadivaysi anjengethu Oyinyumba nasal oxygen cantula Neonatal 2mm IBanga II II Medical nalokhu kucatshangelwa phambili. Umklamo we-prongs ngokwawo uqobo uyabucayi - badinga ukulingana kahle nangokuphephile ngaphandle kokudala ingcindezi engafanele, ngenkathi besavumela ukusebenza ngempumelelo Ukulethwa komoya-mpilo e- Amanani aphezulu okugeleza.
Ubuqotho Bonke HFNC Circkan, kufaka phakathi amashubhu nezixhumi, kubalulekile. Kufanele ikwazi ukuphatha okufudumele, ukugeleza okuphezulu okuphezulu igesi ngaphandle kokushibilika, ukuvuza, noma okubangela ukuncishiswa ngokweqile. Inzalo, lapho kudingeka khona (yize abaningi HFNC Ukuhlangana kweziguli kuhlanzekile kunokuba unyumba, kuya ngohlelo kanye nezinqubomgomo zendawo), kungenye into engaxoxiswanga. Izinqubo zethu zokukhiqiza zinamathela kumazinga aqinile aphesheya anjenge-ISO 13485, futhi imikhiqizo yethu ivame ukuphatha ukumaka kwe-CE, okuyizinkomba ezibalulekile zekhwalithi nokuhambisana nezimpahla zokuthengwa kwezempahla ezinjengeMark Thompson Bheka. Siyakuqonda lokho Iziguli ezinesibi izingqinamba zokuphefumula, ukuthembeka kwazo zonke izakhi zazo I-HFNC Therapy kubalulekile.
Ngaphezu kwalokho, ukungaguquguquki ekukhiqizeni kubalulekile. I-batch ngayinye ye I-Nasal Canlulae noma okunye HFNC Izakhi kumele zihlangabezane namazinga aphezulu afanayo. Lokhu kufaka phakathi amasheke okulawulwa kwekhwalithi aqinile ezigabeni eziningi zokukhiqiza, kusuka ekuhlolweni okubonakalayo okungavuthiwe ekuhlolweni komkhiqizo wokugcina. Sitshala imali kubuchwepheshe obuthuthukisiwe bokukhiqiza kanye nokuqeqeshwa kwabasebenzi ukuqinisekisa ukuthi HFNC umkhiqizo ushiya indawo yethu, noma ngabe kulula I-Nasal Cannula noma isakhi esiyinkimbinkimbi se- Ukwelashwa komoya-mpilo kanye nomoya omncane wokuvalela ukuqhubeka, kwenza njengoba bekulindelekile. Lokhu kunikezelwa kwekhwalithi ukuthi sakha ngayo ukwethembana namakhasimende ethu e-B2B - izibhedlela, imitholampilo kanye nabasabalalisi bezokwelapha emhlabeni jikelele abathembela kithi ngokuphephile futhi okusebenzayo umoya-mpilo ophakeme kakhulu Izinhlelo zokulethwa. Lokhu kugxila kwikhwalithi kufinyelela kulo lonke uhla lwethu, kufaka phakathi Ukunqwabelana kwezokwelapha okuxhumeka ishubhu 1.8mm nge-yankier, Ukuqinisekisa ukusebenza okuthembekile kuyo yonke impahla yethu yezokwelapha.
10. Ukucatshangelwa okubalulekile kokuthengwa kwempahla: Ukuthola amasistimu athembekile we-HFNC kanye nokuhlinzekwa
Abaphathi bokuthengwa kwempahla afana noMark Thompson e-USA, noma noma ngubani obhekele ukudonsa HFNC Amasistimu kanye nezinto zokudla ezibhedlela, imitholampilo, noma izinhlangano zezempilo, ukucatshangelwa okuningana okubalulekile kuza kudlalwa. Okokuqala, ngokungangabazeki, Ukuqinisekiswa kwekhwalithi kanye nokuhambisana nokulawula. Udinga ukuqinisekisa ukuthi HFNC amadivaysi nezingxenye zawo, ikakhulukazi I-Nasal Canlulae kanye nemibuthano, ihlangabezana nezindinganiso zezokwelapha eziqinile. Funa izitifiketi ezinjenge-ISO 13485, ukumaka ama-CE, kanye ne-FDA imvume lapho kusebenza khona. Njengomenzi, siyaqonda lezi zidingo futhi siqinisekise imikhiqizo yethu, njengasethu HFNC-qondabane umoya-mpilo we-nasal ICannulul, hlangana nalezi zimpawu zomhlaba wonke. Ukuqinisekisa lezi zitifiketi ngqo ngomenzi noma ngokuhlolwa okungokwesithathu okudumile kuyisinyathelo esibucayi.
Okwesibili, cabanga Ukusebenza Nezici ye HFNC uhlelo. Ingabe inikeza uhla olubanzi Amanani wokugeleza futhi ngokunembile Fio2 ukulawula? Uhlelo lokunikezwa umswakama lusebenza kahle futhi luthembekile emandleni ayo -nesihawu igesi? Kuthiwani ngezinketho ezibonakalayo ezibonakalayo - kukhona osayizi abahlukahlukene be Ama-prongs we-nasal etholakalayo ukuze ilingane neziguli ezahlukene, kusuka Iziguli zabantu abadala nezingane? Umsebenzisi-ubungane bezisebenzi zemitholampilo nazo zibalulekile - kulula kangakanani ukugeleza kwedivayisi ukusetha, ukusebenza, nokuhlanzeka? Lezi zinto zithinta ngqo ukusebenza kwe- I-HFNC Therapy kanye nomsebenzi wokuhlinzekwa kwabahlinzeki bezempilo. Le khasi Ukugeleza KwaMax amandla, ukunemba kwe Izinga lokugeleza kwegesi ukulethwa, kanye nekhono lohlelo lokugcina Ingcindezi ye-Airway zonke ziyizici zobuchwepheshe zokuhlola.
Ekugcineni, Ukwethenjwa nokusekelwa zibalulekile. Udinga umphakeli ongaqinisekisa ukuthi kube nokuhlinzekwa okutholakalayo, ikakhulukazi izingxenye ezilahlayo ze HFNC uhlelo. Iziphi izikhathi zabo zokuhola? Iyini irekhodi labo lokulethwa kwe-on-time? Ngaphesheya kwezinto, cabanga ukwesekwa ngemuva kokuthengisa, izinsiza zokuqeqesha, kanye newaranti enikelwe. Ukubhekana nomenzi odumile noma umsabalalisi oqonda ubuhlobo obubucayi be Therapy we-oksijini nemikhiqizo ye Ukwehluleka kokuphefumula kwe-acute kungavimba amakhanda amaningi. Intengo ihlala iyinto, kepha kufanele ilinganiswe ngokumelene nekhwalithi, ukuthembeka, kanye nenani eliphelele HFNC Uhlelo luletha ukunakekelwa kweziguli. Isibonelo, kubiza kakhulu kepha kunokwethenjelwa kakhulu I-High Flow Nasal Cannula ethuthukisa imiphumela yeziguli futhi inciphise ubungozi bezinkinga noma Izinga lokuqonda inikeza inani elingcono lesikhathi eside. Ukwakha ubudlelwano obuqinile nabaphakeli abanobala ngezinqubo zabo zokukhiqiza kanye nekhwalithi ye HFNC futhi kuhlobene Izinhlelo ze-oksijini zokulethwa ukhiye we Ukunakekelwa Okubanzi Med na- ukunakekela okuthile Iminyango.
I-Key Takeaways on High-Flow Nasal Cannula (HFNC) Therapy:
- I-HFNC ihambisa amanani aphezulu okugeleza komoya afudumele nomoya-oxygen, edlula izimfuno ezikhuthazayo zeziguli zeFio2 ezinzile.
- Izindlela ezibalulekile zifaka ukuwasha kwesikhala esifile se-nasopharyngeal, isizukulwane sengcindezi yomoya enesizotha, nokulethwa okungaguquki kwe-Fio2.
- Umswakama ofanele ubalulekile Ngenduduzo yesiguli, impilo ye-airway, kanye ne-HFNC ukubekezelelana.
- Izinga lokugeleza lithinta ukuqina kwe-Fio2, ukukhishwa kwesikhala okufile, nomsebenzi wokuphefumula.
- I-HFNC ikhonjiswa ukwehluleka kokuphefumula kobuhlungu be-hypoxemic, ukwesekwa kwe-post-pulwation, nezinye izimo ezidinga ukwelashwa komoya-mpilo othuthukisiwe.
- Kunganciphisa isidingo somoya wokuzihlanya Ezigulini ezikhethwe ngokufanele ngokuhluleka kokuphefumula okukhulu.
- Izinzuzo ezingokoqobo zifaka induduzo ethuthukisiwe yesiguli, ukusetshenziswa kalula, kanye nokuguquguquka kwamanye amazwe kuzo zonke izilungiselelo zemitholampilo ezahlukahlukene.
- Ukukhiqizwa kwekhwalithi yezakhi ze-HFNC, ikakhulukazi i-cancculae ye-nasal, kubalulekile Ukuphepha kanye nokusebenza ngempumelelo, kudinga ukubambelela emazingeni ebanga lezokwelashwa.
- Ukuthengwa kufanele kugxile kwikhwalithi, ukuhambisana nokulawula, izici zokusebenza, kanye nokwethenjwa kwabahlinzeki lapho sithola amasistimu we-HFNC.
Lokhu kuhlola HFNC iqokomisa indima yayo ebalulekile ekunakekelweni kokuphefumula kwanamuhla. Njengomenzi, thina e-zhongxing siyaziqhenya ngokufaka isandla kulo mkhakha ngokunikeza izinto ezisezingeni eliphakeme zezokwelapha ezisekelwa ngempumelelo I-High Flow Nasal Cannula Ukwelapha, Ukusiza Ukuthuthuka umoya-mpilo nemiphumela yeziguli emhlabeni wonke.
Isikhathi sePosi: Meyi-20-2025