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Humidified High-Flow Nasal Cannula
高流动增湿鼻插管
Respiratory support of the newborn, in particular that of preterm neonates, has long been a mainstay of neonatal care. Balancing the need for appropriate support with the potential for lung damage frequently caused by such support is one of the key factors in selecting the desired mode of support, as well as how and for how long it is applied. The job of clinicians is to select the best treatment for the neonate that can provide effective respiratory support when needed, ideally selecting the most effective, least invasive, and gentlest means of support.
为新生儿，尤其是早产儿准备的呼吸支持设备已成为新生儿护理中一个重要项目。衡量合适的支持设备和由这类设备容易引发的肺损伤是选择适合的支持方式的一个主要因素，同时也要考虑如何使用和使用时长。临床医生的任务就是在新生儿需要的时候为他们挑选最好的治疗方式，有效的提供呼吸支持。理想的支持挑选是最有效、伤害性最小、最温和的方式。
In recent years, the use of humidified high-flow nasal cannula (HHFNC) therapy has become wide-spread. The exact role of HHFNC
has been somewhat loosely defined, but it has become increasingly popular as a support modality in situations when continuous positive airway pressure (CPAP) might traditionally have been used. The trend to provide HHFNC instead of CPAP appears at least in part due to the perceived greater ease of use of the former, as well as reports of improved patient tolerance and possibly greater efficacy with HHFNC. This review aims to explore the evidence base for the use of HHFNC in the neonatal population, in particular its use as a substitute for, or in lieu of, CPAP.
近年来，高流动增湿鼻插管疗法(HHFNC)得到广泛应用。HHFNC疗法的定义并不十分严格，但相比传统的持续正压通气疗法(CPAP)，HHFNC疗法越来越受到大众欢迎。HHFNC 代替CPAP的趋势在某种程度上由于较前者更简易的操作、改善患者抗体和更好疗效的可能性。此文献在于探讨实证HHFNC疗法在新生儿中的应用，尤其是作为一种替代CPAP的疗法。
IS HHFNC THERAPY A FORM OF CPAP? HHFNC是CPAP的一种表现形式吗？
When comparing HHFNC and CPAP, an important question to ask is whether or not HHFNC is in fact a form of CPAP. If so, is it
better than what might be considered conventional CPAP, and how and why might that be the case?
比较HHFNC 和CPAP两种疗法，一个重要的问题是HHFNC本质上是否是CPAP的一种表现形式。如果是的话，将HHFNC就看成传统的CPAP不是更好？为什么呢？ WHAT IS CPAP? 什么是CPAP？
The acronym CPAP reflects a positive pressure applied to the airways of a spontaneously breathing patient throughout the respiratory cycle.It may be generated via continuous flow or variable flow of gas, which is typically heated and humidified, in principle via a closed circuit (ie, one in which pressure is maintained by gas flow through a sealed or “closed” respiratory circuit from the point of gas inflow to the terminal outflow, while some portion of the gas is inhaled and exhaled by the patient). Continuous-flow CPAP is generated using a constant flow of gas throughout the respiratory cycle directed against the resistance of the expiratory limb of the circuit. Commonly used methods of generating continuous-flow CPAP include ventilator-derived (using variable resistance in a valve), bubble or water-sealed devices, and, in some countries,
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the Benveniste gas-jet valve (Dameca, Copenhagen, Denmark). Variable-flow CPAP generates pressure at the airway proximal to the nares, and utilizes a number of principles of physics and physiology to provide a constant airway pressure at flows that vary with inspiration and expiration, thereby decreasing certain components of work of breathing (WOB) when compared with continuous-flow CPAP. Variable-flow CPAP devices include the Infant Flow Nasal CPAP System (VIASYS Healthcare Inc., Coshohocken, Pennsylvania) and the ARABELLA infant nasal CPAP system (Hamilton Medical AG, Bonaduz, Switzerland). At least in design, the aim of each of these devices is to deliver positive air-way pressure that is consistent, predictable, and regulated. The most commonly used interfaces between the CPAP circuit and the neonate are nasal prongs and/or nasal masks.
CPAP 应用于呼吸周期中患者经自然呼吸通道的正压力。它可能经由
持续流或变速流产生加温加湿，原则上，这一过程在一个闭合环道中完成。（例如：由气流造成的持续压力经闭合式呼吸环道从气流流入道最终流出，与此同时，一部分气体将被患者吸入、呼出。）持续流CPAP由一股持续气流贯穿呼吸周期以杜绝周期中呼气相的阻力。常用产生持续气道CPAP的方法包括呼吸机导出（利用在同一阀门上的变阻器）、气泡或水封装置和某些国家使用的Benveniste气体喷流阀（Dameca, 哥本哈根, 丹麦）。变速流CPAP由接近鼻孔处导气管内压
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力和利用物理性和生理机能的一些原理提供的随吸气和呼气而变化的恒定气流。因此，与持续流CPAP相比，变速流CPAP减少了某些呼吸功(WOB)的组成成分。变速流CPAP设备包括Infant Flow Nasal CPAP系统（VIASYS Healthcare Inc.,肯肖霍肯，宾夕法尼亚州）和 ARABELLA infant nasal CPAP系统(Hamilton Medical AG, 博纳图斯, 瑞士)。至少从设计的角度讲，这些设备都是为提供持续的、可预见的、有规律的正压气流。通常用于连接CPAP和新生儿的是鼻插管和/或鼻罩。
The primary goal and effects of CPAP, when effectively applied, is to provide low-pressure distention of the lungs and prevent collapse of the alveoli and terminal airways during expiration.This serves to recruit alveoli and to increase and/or maintain the functional residual capacity (FRC) of the lungs, with secondary benefits including increased lung compliance,
conservation
of
surfactant,
decreased
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intrapulmonary shunting, and increased airway diameter. CPAP最主要的目标和效果是当其有效的应用时，它能提供肺部的低压膨胀并且防止呼气时发生肺泡萎陷和终末气道1。它有助于恢复肺泡健康、增加和/或维持肺部功能残气量(FRC)。它还有助于增加肺顺应性、保护表面活性物质、减少肺内分流、增长导气管直径等。