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

摘要：

目的 探讨俯卧位通气在先天性心脏病术后急性肺损伤患儿中应用的效果。方法 采用便利抽样法，选取2020年4月—2021年12月在上海市某三级甲等儿童专科医院心脏监护室住院的68例患儿作为研究对象，按照区组随机化分为试验组和对照组各34例。试验组在常规护理的基础上进行俯卧位通气，每次持续8 h，每天1次；对照组接受常规护理。比较两组入组后4、8、16 h的呼吸力学指标（经皮血氧饱和度、动态肺顺应性、氧合指数）以及血流动力学指标（心率、收缩压、舒张压及乳酸浓度）；机械通气时间及心脏监护室住院天数；结束机械通气时，非计划性拔管、切口愈合不良、压力性损伤发生率，Braden Q压力性损伤风险评估量表评分，出院时手术切口分类及愈合等级。结果 无脱落病例。不同时间点两组呼吸力学指标、乳酸浓度的组间和时间存在交互效应（P<0.05）。简单效应分析结果显示，入组后4、8、16 h，试验组经皮血氧饱和度、动态肺顺应性和氧合指数均高于对照组，差异具有统计学意义（P<0.001）；试验组乳酸浓度均低于对照组，差异具有统计学意义（P<0.05）。试验组机械通气时间和心脏监护室住院天数均少于对照组，差异具有统计学意义（P<0.05）。机械通气过程中，两组均未发生非计划性拔管、切口愈合不良、压力性损伤；结束机械通气时，两组Braden Q压力性损伤风险评估量表评分比较，差异无统计学意义（P=0.907）；出院时两组手术切口分类均为Ⅰ类切口，愈合等级均为甲级愈合。结论 在先天性心脏病术后急性肺损伤患儿中，实施俯卧位通气具有安全性和可行性，有助于改善患儿的呼吸功能和血液循环。

关键词: 先天性心脏病, 俯卧位, 急性肺损伤, 儿科护理学