关键词: 先天性心脏病, 俯卧位, 急性肺损伤, 儿科护理学

Abstract:

Objective To investigate the feasibility and effectiveness of the prone position ventilation technique for the pulmonary protection strategies of pulmonary injury in children with congenital heart disease（CHD） received cardiac surgery. Methods 68 children hospitalized in the CICU of Children’s Hospital of Fudan University from April 2020 to December 2021 were selected as the study participants by convenience sampling. A block randomization method was employed to assign these children into a study group and a control group. The study group received routine nursing care and prone position ventilation for 8 h，while the control group only received routine nursing care after CHD surgery. The respiratory mechanic indexes“percutaneous oxygen saturation（SpO₂），oxygenation index （OI），dynamic pulmonary compliance” and hemodynamic indexes“HR，SBP，DBP and blood lactic acid” at 4 h，8 h and 16 h were compared between 2 groups；mechanical ventilation duration and CICU duration were compared；unplanned extubation，insufficient wound healing，pressure-related injury，Braden Q pressure-related injury risk score，surgical incision classification and healing grade between 2 groups were also be compared after mechanical ventilation was finished. Results None of a case dropped out. There were interactive effects on groups and times for respiratory mechanic indicators and blood lactic acid（P<0.05）. Simple effect analysis results showed that the SpO₂，dynamic pulmonary compliance and OI in the study group were higher than those in the control group at 4 h，8 h and 16 h，and the differences have statistical significance（P<0.001）. Blood lactic acid in the study group were lower than it in the control group，and the difference have statistical differences（P<0.05）. The mechanical ventilation duration and ICU days in the study group were lower than it in the control group，and the differences have statistical significance（P<0.05）. No pressure-related injury，unplanned intubation and insufficient wound healing occurred during the process. The Braden Q pressure-related injury score have no statistical difference between 2 groups（P=0.907）. All the surgical incision sites were type I incision and class A healing. Conclusion Prone position ventilation is a suitable ventilation strategy for clinical application in CHD children who received cardiac surgery with a postoperative acute pulmonary injury. It was beneficial to improve the respiratory and circulation function of patients with good safety and feasibility.

Key words: Congenital Heart Disease, Prone Position, Acute Lung Injury, Pediatric Nursing