俯臥位通氣在小兒先心病術(shù)后低氧血癥中的臨床應(yīng)用

陳軍仿 宋云林

[摘要] 先天性心臟病占所有出生人口缺陷的第一位，目前通常采用手術(shù)治療，術(shù)后易出現(xiàn)低氧血癥，近幾年主要通過(guò)采用俯臥位通氣，即將患兒翻轉(zhuǎn)為俯臥位姿勢(shì)，達(dá)到改善氧合指數(shù)的一種治療方式。俯臥位通氣是可有效改善患兒氧合，降低病死率，可逆轉(zhuǎn)難治性低氧血癥的一種肺保護(hù)性通氣策略。俯臥位通氣已被許多臨床試驗(yàn)證實(shí)具有良好的治療效果，目前也得到了臨床的普遍認(rèn)可，其簡(jiǎn)單易行，無(wú)需特殊設(shè)備。通過(guò)學(xué)習(xí)俯臥位通氣在嬰幼兒先心病術(shù)后低氧血癥中改善氧合的機(jī)制、具體實(shí)施，及俯臥位通氣的安全有效性、并發(fā)癥、禁忌證等方面內(nèi)容，為俯臥位通氣在嬰幼兒先心病術(shù)后出現(xiàn)低氧血癥的臨床應(yīng)用中提供一些參考依據(jù)，從而將俯臥位通氣更加廣泛、正規(guī)地應(yīng)用于先心病術(shù)后低氧血癥的患兒。

[關(guān)鍵詞] 俯臥位通氣;小兒;氧合指數(shù);先心病

[中圖分類號(hào)] R473.6? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1673-9701（2021）21-0188-05

The clinical application of prone position ventilation in the treatment of hypoxemia in children with congenital heart disease

CHEN Junfang? ?SONG Yunlin

The First Affiliated Hospital of Xinjiang Medical University， Urumqi? ?830054， China

[Abstract] Congenital heart disease accounts for the first place in all birth defects. At present， surgical treatment is usually used， and hypoxemia is prone to occur after surgery. In recent years， we have adopted prone position ventilation， which is to turn the child into the prone position to improve the oxygenation index. Prone position ventilation can effectively improve the oxygenation of patients， reduce the mortality rate， and can reverse refractory hypoxemia as a lung protective ventilation strategy. Prone position ventilation has been proven by many clinical trials to have a good therapeutic effect， and it has also been widely recognized in clinical practice. It is simple and easy to use and does not require special equipment. By learning the mechanism and specific implementation of prone position ventilation to improve oxygenation in infants and young children with congenital heart disease postoperative hypoxemia， as well as the safety and effectiveness of prone position ventilation， complications， and contraindications， it provides some reference for the clinical application of prone ventilation in infants and young children with hypoxemia after congenital heart disease. Therefore， prone position ventilation can be more widely and formally applied to children with hypoxemia after congenital heart disease.

[Key words] Prone position ventilation; Children; Oxygenation index; Congenital heart disease

小兒先天性心臟病（Congenital heart disease，CHD）是一種小兒較為常見(jiàn)的心血管疾病，發(fā)病率約為1%[1]。先心病是在胚胎發(fā)育階段，因自身發(fā)育問(wèn)題導(dǎo)致的解剖結(jié)構(gòu)異常，或者在出生之后通道未能自行關(guān)閉所致[2]，先天性心臟病根治方法目前仍是手術(shù)治療[3]。先心病患兒異常的血流動(dòng)力學(xué)對(duì)肺血管發(fā)育及呼吸功能具有不良影響，且心臟手術(shù)過(guò)程復(fù)雜，手術(shù)時(shí)間較長(zhǎng)，采用全身麻醉及低溫體外循環(huán)輔助，體外循環(huán)本身可導(dǎo)致血液稀釋、心肺等臟器的缺血再灌注損傷及各種炎癥因子的激活和釋放，故術(shù)后可引起肺血管阻力增高，肺泡毛細(xì)血管滲出，氣道分泌物增多，易誘發(fā)呼吸系統(tǒng)并發(fā)癥[3-5]。另一方面，胸腔開(kāi)放引起肺順應(yīng)性和體積增加，潛在增加了肺剪切傷和撕裂傷，這也導(dǎo)致更大的肺功能障礙[6]，此外小兒由于肺功能發(fā)育尚未成熟，免疫及代償能力低下[7]，故術(shù)后出現(xiàn)低氧血癥概率較高，延長(zhǎng)呼吸機(jī)使用時(shí)間，影響患兒的康復(fù)。