2022 年第 3 期 第 17 卷

先天性心脏病患儿术后延迟关胸的临床预后和循环监测结果

Circulatory monitoring results and nursing process of delayed chest closure after cardiac surgery in children with congenital heart disease

作者：荣敬1耿潇潇1邢鑫欣1苏俊武1李雪梅2刘冰1

英文作者：Rong Jing1 Geng Xiaoxiao1 Xing Xinxin1 Su Junwu1 Li Xuemei2 Liu Bing1

单位：1首都医科大学附属北京安贞医院小儿心脏中心，北京100029；2首都医科大学附属北京安贞医院冠心病外科中心二区，北京100029

英文单位：1Pediatric Heart Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Area 2 of Coronary Atherosclerotic Heart Disease Surgery Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：先天性心脏病；延迟关胸；循环系统

英文关键词：Congenitalheartdisease;Delayedchestclosure;Circulatorysystem

• 摘要：

• 目的 探讨先天性心脏病患儿术后延迟关胸的循环监测结果和护理过程。方法  回顾性分析首都医科大学附属北京安贞医院2015年2月至2017年10月收治的22例先天性心脏病术后延迟关胸患儿的临床资料。记录患儿的临床预后，比较不同预后组的中心静脉压、左心房压、收缩压、心率和血乳酸水平等循环监测结果。结果 22例患儿均在血流动力学稳定后入手术室行二期关胸，延迟关胸时间（2.6±1.3）d，住院时间（37±20）d。痊愈出院16例（痊愈组），多器官功能衰竭死亡6例（死亡组）。死亡组血乳酸水平高于痊愈组［(7.3±3.1)mmol/L比（1.9±0.8）mmol/L］（P<0.05），2组中心静脉压、左心房压、收缩压、心率比较差异均无统计学意义（均P>0.05）。结论  心脏手术后延迟关胸有利于先天性心脏病患儿度过术后早期心肌水肿、低心排血量的高危期，但需配合严密、科学、合理的循环系统监护和护理，以维持良好的循环，改善预后。

• Objective   To investigate the circulatory monitoring results and nursing process of delayed chest closure after cardiac surgery in children with congenital heart disease. Methods   The clinical data of 22 children with delayed chest closure after congenital heart disease treated in Beijing Anzhen Hospital, Capital Medical University from February 2015 to October 2017 were analyzed retrospectively. The clinical prognosis of children was recorded, and the circulatory monitoring results such as central venous pressure (CVP), left atrial pressure, systolic pressure, heart rate and blood lactic acid level in different prognosis groups were compared. Results  After hemodynamic stability, 22 children entered the operating room for secondary chest closure. The delayed chest closure time was (2.6±1.3)d and the length of stay was (37±20)d. Sixteen cases were cured and discharged (recovery group), and 6 cases died of multiple organ failure (death group). The level of blood lactic acid in the death group was higher than that in the recovery group［(7.3±3.1) mmol/L vs (1.9±0.8) mmol/L］ (P<0.05). There were no significant differences in CVP, left atrial pressure, systolic pressure and heart rate between the two groups (all P>0.05). Conclusions Delayed chest closure after cardiac surgery is conducive to children with congenital heart disease through the high-risk period of early postoperative myocardial edema and low cardiac output, but it needs to be combined with strictly, scientifically and reasonably circulatory system monitoring and nursing to maintain good circulation and improve prognosis.