小儿先心病肺高压术后呼吸道护理的策略.docVIP

小儿先心病肺高压术后呼吸道护理的策略 　　【摘要】 目的：探讨先天性心脏病（先心病）伴肺动脉高压（肺高压）患儿术后呼吸道护理方法。方法：对67例先心病伴肺高压患儿进行围手术期护理，术前心理护理、咳痰训练、预防感染及吸痰护理至关重要；术后为患儿安置合适的体位，正确选择呼吸机型号和设置呼吸机参数，气道的湿化与保护，气管插管的护理，间歇性按需吸痰，掌握拔管指征及拔管后呼吸道管理，注重呼吸道护理等一系列的护理措施。结果：67例患儿术后肺动脉压力控制理想，无一例死亡，无高血压危象等并发症发生。结论：先心病伴肺高压患儿通过全面的围手术期呼吸道护理，可以降低死亡率及术后并发症的发生率。 　　【关键词】 先天性心脏病； 肺动脉高压； 呼吸道护理 　　【Abstract】 Objective：To investigate the postoperative respiratory tract nursing methods of children congenital heart disease and pulmonary hypertension.Method：67 children with congenital heart disease and pulmonary hypertension underwent perioperative nursing，preoperative psychological nursing，expectoration training，prevent infection and sputum suction nursing were essential.The right position was placed for children after surgery，corrected selection of breathing machine，and set up the breathing machine parameters，airway moist and protection，the nursing of trachea cannula，intermittent on-demand sputum suction，mastered the extubation indications and airway management after extubation，focused on respiratory tract nursing and so on a series of nursing measures.Result：The postoperative pulmonary arterial pressure of 67 children were controlled in the ideal，no one case death，no complications such as hypertensive crisis.Conclusion：Children with congenital heart disease and pulmonary hypertension through comprehensive perioperative respiratory tract nursing，can reduce the incidence of mortality and postoperative complications. 　　【Key words】 Congenital heart disease； Pulmonary arterial hypertension； Respiratory care 　　First-author’s address：The Fourth People’s Hospital of Shenyang City，Shenyang 110031，China 　　doi：10.3969/j.issn.1674-4985.2015.35.026 　　先天性心脏病（Congenital heart disease，CHD，简称先心病）是指在胚胎发育过程中受各种内外因素的影响，心脏及大血管发育异常所导致的先天性畸形。CHD是新生儿最常见的出生缺陷之一，约占活产婴儿的0.8%，是我国5岁以下儿童先天性疾病造成患儿死亡的第一位原因[1-2]。CHD患儿常合并肺动脉高压，术前均存在不同程度的心肺功能损害，如肺小动脉血管痉挛、内膜增生和重构，影响患儿呼吸，从而导致低氧血症和高碳酸血症，同时术后早期多数患儿可能出现酸碱平衡紊乱和电解质失衡，加之吸痰等护理操作及患儿本身苦恼等均会引起肺动脉压的急剧升高，严重者会使肺动脉血压高于体循环血压，即肺动脉高压危象[3-5]