俯卧位管理对预防先天性心脏病合并急性呼吸窘迫综合征患儿呼吸机相关性肺炎的效果研究  

Effect of prone position management on preventing ventilator-associated pneumonia in children with congenital heart disease complicated with acute respiratory distress syndrome

作　　者：吴怡蓓 陈琳 罗雯懿[2] 包睿 Wu Yibei;Chen Lin;Luo Wenyi;Bao Rui(Department of Cardiovascular Intensive Care Unit,Shanghai Children′s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Nursing,Shanghai Children′s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科监护室,上海200127 [2]上海交通大学医学院附属上海儿童医学中心护理部,上海200127

出　　处：《中国实用护理杂志》2023年第24期1853-1858,共6页Chinese Journal of Practical Nursing

基　　金：上海交通大学医学院2021年护理学科人才队伍建设项目(SJTUHLXK2021);护理高原学科建设百人计划(Hlgy1910kygg)。

摘　　要：目的构建儿童俯卧位管理方案并评价其在预防先天性心脏病合并急性呼吸窘迫综合征儿童呼吸机相关性肺炎(VAP)中的效果,以期为临床实际应用提供经验。方法本研究为类实验研究,采用便利抽样法选择2018年6月至2021年12月上海交通大学医学院附属上海儿童医学中心心胸外科监护室行机械通气的先天性心脏病手术的患儿为研究对象。2018年6月至2019年12月入院的80例患儿为对照组,采用常规VAP的护理措施;2020年1月至2021年12月入院的42例患儿为干预组,在对照组的基础上采用俯卧位护理方案。比较2组患儿VAP发生率、机械通气时长、ICU滞留时长、氧合指数以及不良事件发生率的差异。结果干预组患儿VAP发生率、机械通气时长分别为4.8%(2/42)、67.50(55.00,101.50)h,低于对照组的35.0%(28/80)、92.50(68.00,142.00)h,差异均有统计学意义(χ^(2)=11.98,Z=3.40,均P<0.01),且干预组氧合指数上升趋势优于对照组(F_(交互)=8.38,P<0.05)。2组患儿ICU滞留时长、不良事件发生率比较差异均无统计学意义(均P>0.05)。结论先天性心脏病合并急性呼吸窘迫综合征患儿应用俯卧位通气方案,可明显改善氧合指数,缩短机械通气时间,降低VAP发生率,且具有安全性。Objective To develop a prone position management program and evaluate its effectiveness in preventing ventilator-associated pneumonia(VAP)in children with congenital heart disease combined with acute respiratory distress syndrome,in order to provide experience for clinical application.Methods This was a quasi-experimental study.Convenient sampling method was used to select children with congenital heart defect who underwent mechanical ventilation in the Cardiothoracic Surgical Care Unit of Shanghai Children′s Medical Center,Shanghai Jiao Tong University,School of Medicine from June 2018 to December 2021 as the study subjects.The control group consisted of 80 hospitalized children from June 2018 to December 2019.They were used general nursing interventions to prevent VAP.The 42 hospitalized children from January 2020 to December 2021 were the intervention group,who usd the prone position management program on the basis of the control group.The differences in the incidence of VAP,duration of mechanical ventilation,duration of ICU stay,oxygenation index and the incidence of adverse events between the two groups were compared.Results The incidence of VAP and mechanical ventilation duration in the intervention group were 4.8%(2/42)and 67.50(55.00/101.50),which were lower than 35.0%(28/80)and 92.50(68.00/142.00)of the control group,and the differences were statistically significant(χ^(2)=11.98,Z=3.40,both P<0.01).And the trend of increasing oxygenation index with the intervention group was better than the control group(F=8.38,P<0.05).There was no statistical difference in the incidence of adverse events between the two groups(all P>0.05).Conclusions The application of prone ventilation program with congenital heart disease children complicated with acute respiratory distress syndrome is safe and can significantly improve the oxygenation index,shorten the duration of mechanical ventilation and reduce the incidence of VAP.

关 键 词：呼吸机相关性肺炎 先天性心脏病 俯卧位 

分 类 号：R473.72[医药卫生—护理学]