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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[1] 刘丽, 邢丽娜, 王沅芷, 等. 俯卧位通气对心外科手术后低氧血症患者的影响研究[J]. 中国体外循环杂志, 2025, 23(2): 127-131, 139.LIU L, XING L N, WANG Y Z, et al. Study on the effect of prone position ventilation on patients with hypoxemia after cardiac surgery[J]. Chinese Journal of Extracorporeal Circulation, 2025, 23(2): 127-131, 139. [2] 姜会, 柏晓玲, 成忠莎, 等. 俯卧位通气在体外循环心脏术后低氧血症患者中应用效果的meta分析[J]. 中华护理杂志, 2022, 57(16): 2010-2018.JIANG H, BAI X L, CHENG Z S, et al. Effect of prone ventilation in patients with hypoxemia after cardiopulmonary bypass surgery: a meta-analysis[J]. Chinese Journal of Nursing, 2022, 57(16): 2010-2018. [3] 李颖, 阿曼古丽·莫明, 王正凯, 等. 俯卧位通气在主动脉夹层术后低氧血症中的应用[J]. 中国体外循环杂志, 2022, 20(3): 188-192.LI Y, AMANGULI M M, WANG Z K, et al. Application of prone position ventilation for hypoxemia after aortic dissection[J]. Chinese Journal of Extracorporeal Circulation, 2022, 20(3): 188-192. [4] SUD S, FAN E, ADHIKARI N K J, et al. Comparison of venovenous extracorporeal membrane oxygenation, prone position and supine mechanical ventilation for severely hypoxemic acute respiratory distress syndrome: a network meta-analysis[J]. Intensive Care Med, 2024, 50(7): 1021-1034. doi: 10.1007/s00134-024-07492-7 [5] DING F Y, ZHANG Z D, QIAO G, et al. Early prone position ventilation in the efficacy for severe hypoxemia and neurological complications following acute type A aortic dissection (TAAD) surgery[J]. Int J Neurosci, 2025, 135(12): 1273-1281. doi: 10.1080/00207454.2024.2327408 [6] 胡静, 程云清, 霍建峰, 等. 俯卧位通气在Stanford A型主动脉夹层术后并发中重度低氧血症患者中的应用效果观察[J]. 临床护理研究, 2025, 34(15): 76-78, 192.HU J, CHENG Y Q, HUO J F, et al. Observation on the application effect of prone position ventilation in patients with moderate to severe hypoxemia after Stanford type A aortic dissection surgery[J]. Linchuang Huli Yanjiu, 2025, 34(15): 76-78, 192. [7] LI J, YU Q F, JIAN Z, et al. The impact of prone ventilation on hypoxemia following extracorporeal cardiac surgery: a meta analysis[J]. Altern Ther Health Med, 2024, 30(12): 335-339. [8] GATTINONI L, BRUSATORI S, D'ALBO R, et al. Prone position: how understanding and clinical application of a technique progress with time[J]. Anesthesiol Perioper Sci, 2023, 1(1): 3. DOI: 10.1007/s44254-022-00002-2. [9] 陶建, 宋亚敏, 万颖颖, 等. 心脏病开胸术后俯卧位通气清单式管理效果观察[J]. 护理学杂志, 2023, 38(20): 25-30.TAO J, SONG Y M, WAN Y Y, et al. Effect of applying checklist for performing prone positioning during mechanical ventilation after thoracotomy for open-heart surgery[J]. Journal of Nursing Science, 2023, 38(20): 25-30. [10] CHAO Y L, YUAN X Y, ZHAO Z Q, et al. Physiologic effects of prone positioning on gas exchange and ventilation-perfusion matching in awake patients with AHRF[J]. BMC Pulm Med, 2024, 24(1): 600. DOI: 10.1186/s12890-024-03411-0. [11] 贾敏. 早期俯卧位通气在主动脉夹层术后低氧血症患者中的护理应用效果分析[J]. 实用临床护理学电子杂志, 2022, 7(15): 72-75.JIA M. Analysis of the nursing application effect of early prone position ventilation in patients with hypoxemia after aortic dissection surgery[J]. Shiyong Linchuang Hulixue Dianzi Zazhi, 2022, 7(15): 72-75. [12] 刘言一, 朱海娟, 董文鹏, 等. 预存式自体血回输技术在择期体外循环心脏手术中的临床应用[J]. 中华全科医学, 2023, 21(1): 33-36. doi: 10.16766/j.cnki.issn.1674-4152.002805LIU Y Y, ZHU H J, DONG W P, et al. Clinical application of preoperative autologous blood donation in selective cardiac surgery under extracorporeal circulation[J]. Chinese Journal of General Practice, 2023, 21(1): 33-36. doi: 10.16766/j.cnki.issn.1674-4152.002805 [13] OLMOS M, ESPERATTI M, FUENTES N, et al. Early physiologic changes after awake prone positioning predict clinical outcomes in patients with acute hypoxemic respiratory failure[J]. Intensive Care Med, 2024, 50(12): 2105-2113. doi: 10.1007/s00134-024-07690-3 [14] SILVA C J, MADEIRA S, ABECASIS J, et al. Long-standing hypoxaemia in complex adult congenital heart disease: anatomical and functional interplay in an uncommon presentation[J]. BMJ Case Rep, 2022, 15(3): e248330. DOI: 10.1136/bcr-2021-248330. [15] 张美燕, 何芬惠, 蓝流富, 等. 俯卧位通气应用于冠状动脉旁路移植术后低氧血症患者的效果观察[J]. 大医生, 2024, 9(8): 1-3.ZHANG M Y, HE F H, LAN L F, et al. Observation on the effect of prone position ventilation in patients with hypoxemia after coronary artery bypass grafting[J]. Da Yisheng, 2024, 9(8): 1-3. [16] 王佳妮, 赵妹, 张辰, 等. 俯卧位通气在心血管外科开胸术后患者低氧血症中应用的研究进展[J]. 当代护士, 2024, 31(27): 28-31.WANG J N, ZHAO M, ZHANG C, et al. Research progress on the application of prone position ventilation in patients with hypoxemia after cardiovascular open-chest surgery[J]. Modern Nurse, 2024, 31(27): 28-31. [17] LIANG H W, DENG Q X, YE W Y, et al. Prone position ventilation-induced oxygenation improvement as a valuable predictor of survival in patients with acute respiratory distress syndrome: a retrospective observational study[J]. BMC Pulm Med, 2024, 24(1): 575. DOI: 10.1186/s12890-024-03349-3. [18] BARSAN KAYA T, AYDEMIR O, TEKIN A N. Prone versus supine position for regional cerebral tissue oxygenation in preterm neonates receiving noninvasive ventilation[J]. J Matern Fetal Neonatal Med, 2021, 34(19): 3127-3132. doi: 10.1080/14767058.2019.1678133 [19] 程晓凡, 武文静, 赵佳琪, 等. 主动脉夹层术后低氧血症患者俯卧位通气管理的最佳证据[J]. 临床与病理杂志, 2024, 44(10): 1403-1412.CHENG X F, WU W J, ZHAO J Q, et al. Best evidence for prone position ventilation management in hypoxemic patients after aortic dissection surgery[J]. Journal of Clinical and Pathological Research, 2024, 44(10): 1403-1412. [20] 李祥杰, 彭卫. 小儿先天性心脏病围手术期体外膜氧合技术的应用进展[J]. 临床小儿外科杂志, 2022, 21(6): 576-581.LI X J, PENG W. Application advances of extracorporeal membrane oxygenation in pediatric congenital heart disease surgery[J]. Journal of Clinical Pediatric Surgery, 2022, 21(6): 576-581. [21] SUN Y, DENG X M, CAI Y, et al. Post-cardiopulmonary bypass hypoxaemia in paediatric patients undergoing congenital heart disease surgery: risk factors, features, and postoperative pulmonary complications[J]. BMC Cardiovasc Disord, 2022, 22(1): 430. DOI: 10.1186/s12872-022-02838-9. [22] 叶青青, 邵绍鲲, 吕海锋, 等. 俯卧位通气对严重脑功能损伤患者低氧血症的影响[J]. 中国中西医结合急救杂志, 2024, 31(1): 46-49.YE Q Q, SHAO S K, LV H F, et al. Effect of prone position ventilation on hypoxemia in patients with severe brain injury[J]. Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care, 2024, 31(1): 46-49. [23] MARKLIN G F, O'SULLIVAN C, DHAR R. Ventilation in the prone position improves oxygenation and results in more lungs being transplanted from organ donors with hypoxemia and atelectasis[J]. J Heart Lung Transplant, 2021, 40(2): 120-127. doi: 10.1016/j.healun.2020.11.014 [24] 李继梅, 张一杰, 何艳. 不同卧位通气方式应用于心脏外科术后低氧血症中的效果观察[J]. 社区医学杂志, 2022, 20(4): 218-222.LI J M, ZHANG Y J, HE Y. Observation on the effect of different lying ventilation methods in hypoxemia after cardiac surgery[J]. Journal of Community Medicine, 2022, 20(4): 218-222. -
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