小兒高流量鼻套管氧氣治療的臨床應用探討

Applications of High Flow Nasal Cannula in Children

高流量鼻套管（high flow nasal cannula, HFNC）是近年來新興的氧氣治療設備，氣體經過加濕加熱的過程，病人可忍受較高的流量經由鼻子輸送，適用於早產兒、新生兒、兒童到成人。目前研究顯示高流量經鼻套管氧氣治療有舒適性較佳、鼻部損傷比率較低、降低插管機率及減少呼吸器使用天數等優點。高流量鼻套管利用高的流量提供延展性正壓（positive distending pressure, PDP），產生肺部擴張效應，進而改善呼吸功及氧合，延展性正壓的大小除與流量呈正相關，同時也受到許多因素的影響，例如病人體重及嘴巴密合度等影響，臨床上須特別注意流量的設定及鼻套管尺寸的選擇，以避免不良反應的產生。本篇將針對小兒高流量鼻套管的原理、與傳統經鼻持續氣道正壓（nasal continuous positive airway pressure, NCPAP）比較、設備介紹及臨床應用及進行文獻回顧，提供臨床呼吸治療之參考。 High flow nasal cannula (HFNC) is a relatively new device for oxygen therapy. Heated and humidified oxygen gas is more tolerated delivered through nasal cannula. Higher gas flow provides a positive distending pressure, resulting physiological effects of lung expansion, which improves patients' oxygenation and reduces work of breathing. The positive distending pressure is correlated to the flow rate which attentions much be paid to avoid complications. The benefits HFNC provide including, better comfortable level, less nasal trauma, lower endotracheal intubation rate and lower ventilator days. Yet, large randomized trials are desired for further evidence. The high flow nasal cannula can be used in a wide range of patients including, premature infants, neonates, pediatrics, and adults. The objective of the present article was to review the mechanics and clinical applications of HFNC in pediatrics.