早期体位变换对改善先天性心脏病术后延迟关胸患儿肺功能的影响

The impact of early position changing on pulmonary function of delayed sternal closure patients with congenital heart disease after cardiac surgery

目的探讨先心病延迟关胸患儿术后早期进行体位变换对改善肺通气及氧合的效果。方法将72例在体外循环下行先心病纠治术并延迟关胸的患儿按照计算机产生的随机数字分为实验组与对照组。实验组在术后6h采取左侧卧位-右侧卧位-仰卧位交替的体位变换,对照组采取术后6h仰卧位并制动,直至关胸。监测术后6、12、18及24h两组患儿动脉血气中氧分压、二氧化碳分压、动脉血氧饱和度及机械通气氧流量,记录两组患儿机械通气时间、CCU停留时间以及延迟关胸时间。结果实验组术后24h的Pa CO_2低于对照组(P<0.01),Pa02高于对照组(P<0.05);实验组患儿机械通气时间(P<0.05)及CCU停留时间均少于对照组(P<0.05)。结论先心病患儿延迟关胸术后采用左侧-右侧-仰卧位交替变换,可以改善患儿肺功能,缩短术后恢复进程。

Objective To explore the impact of early position changing on pulmonary function of delayed sternal closure children with congenital heart disease after cardiac surgery. Methods This single-center,non-blinded trial recruited 72 children undergoing eardiopulmonary bypass surgery. Computer-generated random numbers were used to assign patients into the experimental group and the control group. In the experimental group,left-right-supine alter- nate position changing was conducted 6 hours after surgery;the control group used fixed supine position until chest closure. PaO2,PaCO2,Sa02 and Fi02 of arterial blood gas were recorded at 6,12,18,and 24 hours after surgery; length of ventilation,CCU staying and delayed chest closure were recorded. Results The experimental group had lower PaC0z（P〈0.01） and higher PaO2（P〈0.05） than the control group at 24 hours after surgery; the length of ventilation （P〈0.05） and CCU staying （P〈0.05） in the experimental group were less than those in the control group. Conclusion Left-right-supine alternate position changing can improve the pulmonary function of children with congen- ital heart disease after surgery.and can oromote the children＇s recovery.