俯卧位通气在小儿先心病术后低氧血症中的临床应用

陈军仿 宋云林

[摘要] 先天性心脏病占所有出生人口缺陷的第一位，目前通常采用手术治疗，术后易出现低氧血症，近几年主要通过采用俯卧位通气，即将患儿翻转为俯卧位姿势，达到改善氧合指数的一种治疗方式。俯卧位通气是可有效改善患儿氧合，降低病死率，可逆转难治性低氧血症的一种肺保护性通气策略。俯卧位通气已被许多临床试验证实具有良好的治疗效果，目前也得到了临床的普遍认可，其简单易行，无需特殊设备。通过学习俯卧位通气在婴幼儿先心病术后低氧血症中改善氧合的机制、具体实施，及俯卧位通气的安全有效性、并发症、禁忌证等方面内容，为俯卧位通气在婴幼儿先心病术后出现低氧血症的临床应用中提供一些参考依据，从而将俯卧位通气更加广泛、正规地应用于先心病术后低氧血症的患儿。

[关键词] 俯卧位通气;小儿;氧合指数;先心病

[中图分类号] R473.6          [文献标识码] A          [文章编号] 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

小兒先天性心脏病（Congenital heart disease，CHD）是一种小儿较为常见的心血管疾病，发病率约为1%[1]。先心病是在胚胎发育阶段，因自身发育问题导致的解剖结构异常，或者在出生之后通道未能自行关闭所致[2]，先天性心脏病根治方法目前仍是手术治疗[3]。先心病患儿异常的血流动力学对肺血管发育及呼吸功能具有不良影响，且心脏手术过程复杂，手术时间较长，采用全身麻醉及低温体外循环辅助，体外循环本身可导致血液稀释、心肺等脏器的缺血再灌注损伤及各种炎症因子的激活和释放，故术后可引起肺血管阻力增高，肺泡毛细血管渗出，气道分泌物增多，易诱发呼吸系统并发症[3-5]。另一方面，胸腔开放引起肺顺应性和体积增加，潜在增加了肺剪切伤和撕裂伤，这也导致更大的肺功能障碍[6]，此外小儿由于肺功能发育尚未成熟，免疫及代偿能力低下[7]，故术后出现低氧血症概率较高，延长呼吸机使用时间，影响患儿的康复。