Application of atomized inhalation combined with tracheoscopy in children with ARDS after congenital heart disease surgery

doi:10.3760/cma.j.issn.1007-1245.2023.18.028

Abstract

Abstract:

Objective　To investigate the application value of nebulizing inhalation combined with tracheoscopy in children with ARDS after congenital heart disease (CHD) surgery. Methods　Sixty children with ARDS after CHD surgery who were admitted to Fuwai Central China Cardiovascular Hospital from August 2022 to March 2023 were selected for the randomized controlled trial. The patients were divided into a control group and an observation group by lottery, with 30 cases in each group. In the control group, there were 19 males and 11 females who were (9.36±1.40) months old; their body weight was (7.66±1.14) kg. In the observation group, there were 17 males and 13 females who were (9.24±1.38) months old; their body weight was (7.58±1.13) kg. All the enrolled children underwent open-heart surgery under extracorporeal circulation and were complicated with ARDS after the surgery. Both groups received routine nursing care for ARDS patients after CHD surgery; in addition, the observation group received atomization inhalation and tracheoscopy. The levels of respiratory function indicators [platform pressure (Pplat), air way peak pressure (Ppeak), and dynamic lung compliance (Cdyn)] 2 h and 3 d after the intervention were compared between the two groups. The postoperative recovery and the incidence of adverse reactions were evaluated in both groups. χ² and t were applied. Results　Two hours and 3 days after the intervention, the PaO₂, SaO₂, PaO₂/FiO₂, and Cdyn in the observation group were higher than those in the control group [(58.42±8.76) mmHg (1 mmHg=0.133 kPa) vs. (53.69±8.05) mmHg, (79.71±11.95) mmHg vs. (69.36±10.40) mmHg, (87.61±13.14)% vs. (80.44±12.06)%, (95.39±14.45)% vs. (88.26±13.23)%, (198.92±29.83) vs. (184.17±26.65), (215.06±32.25) vs. (189.74±28.46), (4.84±0.72) vs. (4.26±0.63), and (6.47±0.97) vs. (4.85±0.72)], with statistical differences (t=2.177, 3.578, 2.201, 2.285, 2.019, 3.224, 3.320, and 7.345; P<0.05). Two hours and 3 days after the intervention, the PaCO₂, Ppeak, and Pplat in the observation group were lower than those in the control group [(37.65±5.64)mmHg vs. (41.71±6.25) mmHg, (32.33±4.84) mmHg vs. (36.45±5.46) mmHg, (23.43±3.51) cmH₂O (1 cmH₂O=0.098 kPa) vs. (25.75±3.86) cmH₂O, (21.76±3.26) cmH₂O vs. (23.85±3.57) cmH₂O, (13.98±2.09)cmH₂O vs. (15.56±2.33) cmH₂O, and (11.76±1.76) cmH₂O vs. (13.92±2.08) cmH₂O], with statistical differences (t=2.641, 3.092, 2.435, 2.367, 2.764, and 4.342; all P<0.05). The duration of mechanical ventilation and ICU stay in the observation group were shorter than those in the control group [(121.48±18.22) h vs. (144.35±21.65) h and (192.66±28.89) h vs. (264.24±39.63) h], with statistical differences (t=4.426 and 7.994; both P<0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group [3.33% (1/30) vs. 20.00% (6/30)],with a statistical difference (χ²=4.043,P<0.05). Conclusion　Atomization inhalation combined with tracheoscopy has significant clinical effects for children with ARDS after CHD surgery, and is conducive to improving the levels of arterial blood gas indicators and respiratory function, promoting their postoperative recovery, and effectively reducing the risk of adverse reactions.

Key words:

先天性心脏病, 急性呼吸窘迫综合征, 雾化吸入, 气管镜检查

摘要：

目的　探讨雾化吸入联合气管镜检查在先天性心脏病（CHD）术后急性呼吸窘迫综合征（ARDS）患儿中的应用价值。方法　选取2022年8月至2023年1月阜外华中心血管病医院收治的CHD术后ARDS患儿60例，采用随机对照研究，并按照随机抽签法将其分为两组，各30例。其中对照组男19例、女11例，年龄（9.36±1.40）个月，体质量（7.66±1.14）kg；观察组男17例、女13例，年龄（9.24±1.38）个月，体质量（7.58±1.13）kg。入组患儿均在体外循环（CPB）下行心内直视手术，且术后合并ARDS，两组患儿均施以CHD术后ARDS患者的常规护理，观察组在此基础上给予雾化吸入联合气管镜检查。比较两组干预2 h、3 d后呼吸功能监测指标［平台压（Pplat）、气道峰压（Ppeak）、肺动态顺应（Cdyn）］水平，评估两组术后恢复情况和不良反应发生率。统计学方法采用χ²检验、t检验。结果　干预2 h、3 d后，观察组动脉血氧分压（PaO₂）、动脉血氧饱和度（SaO₂）、氧合指数（PaO₂/FiO₂）、肺动态顺应（Cdyn）水平均高于对照组［（58.42±8.76）mmHg（1 mmHg=0.133 kPa）比（53.69±8.05）mmHg、（79.71±11.95）mmHg比（69.36±10.40）mmHg、（87.61±13.14）%比（80.44±12.06）%、（95.39±14.45）%比（88.26±13.23）%、（198.92±29.83）比（184.17±26.65）、（215.06±32.25）比（189.74±28.46）、（4.84±0.72）比（4.26±0.63）、（6.47±0.97）比（4.85±0.72）］，差异均有统计学意义（t=2.177、3.578、2.201、2.285、2.019、3.224、3.320、7.345，均P<0.05）；干预2 h、3 d后，观察组动脉血二氧化碳分压（PaCO₂）、气道峰压（Ppeak）、平台压（Pplat）水平均低于对照组［（37.65±5.64）mmHg比（41.71±6.25）mmHg、（32.33±4.84）mmHg比（36.45±5.46）mmHg、（23.43±3.51）cmH₂O（1 cmH₂O=0.098 kPa）比（25.75±3.86）cmH₂O、（21.76±3.26）cmH₂O比（23.85±3.57）cmH₂O、（13.98±2.09）cmH₂O比（15.56±2.33）cmH₂O、（11.76±1.76）cmH₂O比（13.92±2.08）cmH₂O］，差异均有统计学意义（t=2.641、3.092、2.435、2.367、2.764、4.342，均P<0.05）；观察组机械通气、住ICU时间均短于对照组［（121.48±18.22）h比（144.35±21.65）h、（192.66±28.89）h比（264.24±39.63）h］，差异均有统计学意义（t=4.426、7.994，均P<0.05）；观察组不良反应发生率低于对照组［3.33%（1/30）比20.00%（6/30）］，差异有统计学意义（χ²=4.043，P<0.05）。结论　将雾化吸入联合气管镜检查应用于CHD术后合并ARDS患儿，临床效果显著，有利于改善患儿的动脉血气指标和呼吸功能水平，促进患儿术后恢复，降低不良反应的发生风险。

关键词:

先天性心脏病, 急性呼吸窘迫综合征, 雾化吸入, 气管镜检查

Pang Qiuhe, Hu Penghe, Zhu Chunhe, Zhang Yuanyuan.

Application of atomized inhalation combined with tracheoscopy in children with ARDS after congenital heart disease surgery [J]. International Medicine and Health Guidance News, 2023, 29(18): 2636-2641.

庞秋贺胡朋鹤朱春荷张媛媛.

雾化吸入联合气管镜检查在先天性心脏病术后ARDS患儿中的应用研究 [J]. 国际医药卫生导报, 2023, 29(18): 2636-2641.

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