Clinical study on prone position ventilation regulation of oxygenation and circulatory function in children with hypoxemia after congenital heart disease surgery
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摘要:
目的 探讨俯卧位通气应用于小儿先天性心脏病(以下简称先心病)术后低氧血症患儿中对其氧合功能、循环功能的调控作用及临床应用安全性，为临床呼吸干预方案的选择提供依据。 方法 回顾性分析2022年11月—2025年11月首都医科大学附属北京儿童医院收治的160例小儿先心病术后低氧血症患儿的临床资料，将实施仰卧位与侧卧位交替通气干预的80例患儿纳入对照组，将实施间歇性俯卧位通气干预的80例患儿纳入观察组。比较2组通气前和通气4、8、12 h的氧合功能、循环功能指标及并发症发生率。 结果 观察组通气4、8、12 h的动脉血二氧化碳分压(PaCO2)水平分别为(50.35±5.02)mmHg(1 mmHg=0.133 kPa)、(46.15±4.61)mmHg、(41.38±3.97)mmHg，均低于对照组的(53.55±4.92)mmHg、(50.19±4.25)mmHg、(47.71±4.31)mmHg，且2组氧合指数(PaO2/FiO2)、血氧饱和度(SpO2)水平差异均有统计学意义(P＜0.05)。观察组总并发症发生率为6.25%(5/80)，较对照组的23.75%(19/80)更低，差异有统计学意义(P＜0.05)。 结论 伴随通气时间延长，俯卧位通气可改善小儿先心病术后低氧血症患儿氧合功能，维持循环功能稳定，且并发症少，安全有效。 Abstract:Objective This study explores the effects of prone positioning ventilation on oxygenation function, circulatory function regulation, and clinical safety in children with postoperative hypoxemia following congenital heart disease surgery, aiming to provide a basis for selecting respiratory intervention strategies in clinical practice. Methods A retrospective analysis was conducted on the clinical data of 160 children with postoperative hypoxemia due to congenital heart disease admitted to Beijing Children's Hospital Capital Medical University from November 2022 to November 2025. Eighty children who received alternating supine and lateral position ventilation interventions were included in the control group, and 80 children who received intermittent prone position ventilation interventions were included in the observation group. The oxygenation function, circulatory function indicators, and incidence of complications were compared between the two groups before ventilation and at 4, 8, and 12 hours of ventilation. Results The arterial partial pressure of carbon dioxide (PaCO2) levels in the observation group at 4, 8, and 12 h of ventilation were (50.35 ± 5.02) mmHg (1 mmHg=0.133 kPa), (46.15 ± 4.61) mmHg, and (41.38 ± 3.97) mmHg, respectively, all of which were lower than those in the control group[(53.55 ± 4.92) mmHg, (50.19 ± 4.25) mmHg, and (47.71 ± 4.31) mmHg]. Moreover, the differences in arterial partial pressure of oxygen (PaO2)/fraction of inspiration O2 (FiO2) and percutaneous arterial oxygen saturation (SpO2) levels between the two groups were statistically significant (P < 0.05).The total incidence of complications in the observation group was 6.25% (5/80), which was lower than 23.75% (19/80) in the control group, and the difference was statistically significant (P < 0.05). Conclusion Along with prolonged ventilation time, prone position ventilation can improve oxygenation function in children with hypoxemia after congenital heart disease surgery, maintain stable circulatory function, and have fewer complications, making it safe and effective. -
Key words:
- Prone position ventilation /
- Children /
- Congenital heart disease /
- Hypoxemia /
- Oxygenation function /
- Loop function /
- Complication
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表 1 2组小儿先心病术后低氧血症患儿一般临床资料比较
Table 1. Comparison of general clinical data between two groups of children with postoperative hypoxemia after congenital heart disease surgery
组别 例数 性别[例(%)] 年龄(x±s，岁) 体重(x±s，kg) 肺动脉高压分级[例(%)] APACHE Ⅱ评分(x±s，分) 呼吸机使用时间(x±s，d) 男 女 0级 1级 2级 3级 对照组 80 45(56.25) 35(43.75) 5.21±0.78 18.44±3.19 12(15.00) 28(35.00) 30(37.50) 10(12.50) 15.49±2.71 5.53±1.35 观察组 80 48(60.00) 32(40.00) 5.35±0.84 18.79±3.02 14(17.50) 25(31.25) 29(36.25) 12(15.00) 15.66±2.84 5.71±1.62 统计量 0.231a 1.092b 0.713b 0.522c 0.387b 0.763b P值 0.631 0.276 0.477 0.914 0.699 0.446 组别 例数 疾病类型[例(%)] 改良ROSS分级[例(%)] 室间隔缺损 房间隔缺损 动脉导管未闭 法洛四联症 Ⅰ级 Ⅱ级 Ⅲ级 对照组 80 32(40.00) 18(22.50) 15(18.75) 15(18.75) 25(31.25) 38(47.50) 17(21.25) 观察组 80 30(37.50) 20(25.00) 17(21.25) 13(16.25) 23(28.75) 40(50.00) 17(21.25) 统计量 0.438a 0.135c P值 0.932 0.935 注：a为χ2值，b为t值，c为Z值。 
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表 2 2组小儿先心病术后低氧血症患儿通气前后PaCO2比较(x±s，mmHg)
Table 2. Comparison of PaCO2 before and after ventilation between two groups of children with postoperative hypoxemia after congenital heart disease surgery (x±s, mmHg)
组别 例数 通气前 通气4 h 通气8 h 通气12 h F值 P值 对照组 80 58.68±6.12 53.55±4.92 50.19±4.25 47.71±4.31 73.323 ＜0.001 观察组 80 58.84±5.93 50.35±5.02 46.15±4.61 41.38±3.97 180.416 ＜0.001 F值 0.168 4.072 5.763 9.662 P值 0.867 ＜0.001 ＜0.001 ＜0.001 注：F时间=126.745，P时间＜0.001；F组间=10.823，P组间=0.001；F交互=8.962，P交互＜0.001。
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表 3 2组小儿先心病术后低氧血症患儿通气前后PaO2/FiO2比较(x±s，mmHg)
Table 3. Comparison of PaO2/FiO2 before and after ventilation between two groups of children with postoperative hypoxemia after congenital heart disease surgery (x±s, mmHg)
组别 例数 通气前 通气4 h 通气8 h 通气12 h F值 P值 对照组 80 119.73±22.19 131.40±29.75 139.66±32.79 145.58±29.75 12.032 ＜0.001 观察组 80 121.58±24.02 166.81±45.09 182.91±55.73 193.33±50.39 38.849 ＜0.001 F值 0.506 5.863 5.983 7.299 P值 0.614 ＜0.001 ＜0.001 ＜0.001 注：F时间=25.441，P时间＜0.001；F组间=9.635，P组间=0.002；F交互=7.852，P交互＜0.001。
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表 4 2组小儿先心病术后低氧血症患儿通气前后SpO2比较(x±s，%)
Table 4. Comparison of SpO2 before and after ventilation between two groups of children with postoperative hypoxemia after congenital heart disease surgery (x±s, %)
组别 例数 通气前 通气4 h 通气8 h 通气12 h F值 P值 对照组 80 92.29±3.02 93.71±2.28 95.40±2.58 96.19±2.47 35.977 ＜0.001 观察组 80 92.66±2.95 95.31±2.73 96.78±2.44 97.33±2.13 52.390 ＜0.001 F值 0.784 4.023 3.476 3.126 P值 0.434 ＜0.001 0.001 0.002 注：F时间=44.184，P时间＜0.001；F组间=4.256，P组间=0.040；F交互=3.682，P交互=0.013。
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表 5 2组小儿先心病术后低氧血症患儿通气前后HR水平比较(x±s，次/min)
Table 5. Comparison of heart rate before and after ventilation between two groups of children with postoperative hypoxemia after congenital heart disease surgery (x±s, beats/min)
组别 例数 通气前 通气4 h 通气8 h 通气12 h F值 P值 对照组 80 142.18±19.54 144.63±21.54 145.71±20.08 145.05±19.68 0.464 0.708 观察组 80 141.39±20.01 144.78±20.39 145.73±22.03 144.21±20.58 0.646 0.586 F值 0.253 0.045 0.006 0.264 P值 0.801 0.964 0.995 0.792 注：F时间=0.555，P时间=0.645；F组间=0.021，P组间=0.884；F交互=0.048，P交互=0.985。
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表 6 2组小儿先心病术后低氧血症患儿通气前后MAP水平比较(x±s，mmHg)
Table 6. Comparison of mean arterial pressure before and after ventilation between two groups of children with postoperative hypoxemia after congenital heart disease surgery (x±s, mmHg)
组别 例数 通气前 通气4 h 通气8 h 通气12 h F值 P值 对照组 80 77.28±8.25 76.95±7.93 76.78±8.06 77.39±7.58 0.102 0.959 观察组 80 77.91±8.44 77.29±8.61 76.58±7.49 77.56±8.15 0.380 0.768 F值 0.477 0.260 0.163 0.137 P值 0.634 0.795 0.871 0.892 注：F时间=0.241，P时间=0.868；F组间=0.185，P组间=0.667；F交互=0.092，P交互=0.963。
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表 7 2组小儿先心病术后低氧血症患儿通气前后CVP水平比较(x±s，mmHg)
Table 7. Comparison of central venous pressure before and after ventilation between two groups of children with postoperative hypoxemia after congenital heart disease surgery (x±s, mmHg)
组别 例数 通气前 通气4 h 通气8 h 通气12 h F值 P值 对照组 80 9.13±1.30 9.48±1.27 9.55±1.06 9.44±1.32 1.788 0.149 观察组 80 9.09±1.24 9.46±1.05 9.43±0.98 9.50±1.25 2.211 0.087 F值 0.199 0.109 0.743 0.295 P值 0.842 0.914 0.458 0.768 注：F时间=0.109，P时间=0.914；F组间=0.199，P组间=0.842；F交互=0.295，P交互=0.768。
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表 8 2组小儿先心病术后低氧血症患儿并发症发生率比较[例(%)]
Table 8. Comparison of complication rates between two groups of children with postoperative hypoxemia after congenital heart disease surgery [cases (%)]
组别 例数 皮肤压力性损伤 呼吸机相关性肺炎 误吸 导管意外滑脱 合计 对照组 80 6(7.50) 5(6.25) 5(6.25) 3(3.75) 19(23.75) 观察组 80 1(1.25) 1(1.25) 2(2.50) 1(1.25) 5(6.25) 注：2组并发症发生率比较，χ2=9.608，P=0.002。
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