先天性心脏病患儿术后鼻外导管双孔给氧效果探讨

Binasal catheter placed out of the nostrils for oxygen delivery in pediatric patients after congenital heart surgery

目的为先天性心脏病术后患儿选择一种较为理想、安全、有效的吸氧方法,提高氧疗效果。方法选取先天性心脏病术后患儿60例,随机分为三组各20例,于气管插管拔管后分别给予单侧鼻导管给氧、鼻外导管双孔给氧、面罩给氧。监测三组患儿干预前(气管插管拔除前)和干预后(拔除气管插管吸氧1h后)的心率(HR)、呼吸频率(RR)、经皮血氧饱和度(SpO2)、动脉血气分析值(pH值、PaO2、SaO2、PaCO2),以及患儿皮肤是否温暖干燥、口唇是否红润、对治疗的依从性。结果三组HR、RR、pH值、PaCO2、SaO2比较,差异无统计学意义(均P>0.05);三组SpO2、PaO2值及依从性比较,差异有统计学意义(P<0.05,P<0.01)。面罩给氧PaO2最高,鼻外导管双孔给氧依从性最高。结论先天性心脏病术后患儿气管插管拔除后采用3种给氧方法,均能达到良好的氧疗效果;患儿对鼻外导管双孔给氧的依从性优于单侧鼻导管给氧和面罩给氧。但给氧时间仅为1h,长时间应用的氧疗效果需进一步探讨。

Objective To confirm an optimal,safe and effective oxygen delivery method for pediatric patients after congenital heart surgery,and to improve effectiveness of oxygen therapy.Methods Sixty eligible pediatric patients after congenital heart surgery were randomly and equally allocated to three groups to test the three oxygen delivery systems employed after extubation of endotracheal tubes：unilateral nasal cannula placed in the nostril,binasal catheter placed out of the nostrils,and face mask placed securely around the muzzle.Heart rates（HR）,respiratory rates（RR）,pulse oxygen saturation（SpO2）,and arterial blood gas analysis（pH,PaCO2,PaO2,and SaO2）were measured prior to extubation of endotracheal tubes and one hour after oxygen therapy.Children′s skin and lips,as well as their adherence to oxygen therapy were observed.Results There were no statistical differences in HR,RR,pH,PaCO2,and SaO2 among the three groups（P〉0.05 for all）.However,there were significant differences in SpO2,PaO2 and adherence among the three groups（P〈0.05,P〈0.01）,with the face mask group having highest PaO2 and the binasal catheter group having highest adherence.Conclusion All of three oxygen delivery systems used for children after congenital heart surgery can obtain satisfactory efficacy of oxygen therapy,and children were more adherent to binasal catheter.The test lasted only one hour,so the long-term effects of oxygen therapy need to be further studied.