The parents of pediatric congenital heart disease can achieve better surgical results through surgical treatment, but the parents of children after surgery should not be paralyzed as well, but also pay attention to the following points so as to consolidate the surgical effect, prevent various postoperative complications and help children recover as soon as possible after surgery. 1, the temperature of the heart surgery children, intraoperative cooling to 28 ~ 30 ℃, deep hypothermia of children’s body temperature is reduced to 25 ℃, after the operation to warm up 35 ~ 36 ℃. After entering the monitoring room to do a good job to keep warm, generally in winter, should be outside the monitoring room before the sick child into the bed with infrared warming lamp for 10 ~ 15 minutes. After entering the monitoring room, the child should be illuminated and covered according to the body temperature to prevent the body temperature from rising and hyperthermia. In the past, rebound hyperthermia tended to occur within 24 hours after surgery, but currently it is less common. Once hyperthermia occurs, physical or pharmacological cooling is usually given according to the circulatory system, and water bags (especially for small infants, both for cooling and preventing decubitus ulcers) or ice bags can be placed on the head, and anal plugs or alcohol and ice water can be used to scrub the inner surface of the joints of the extremities and the back. 2. Management of respiratory tract 1)
Most of the children after cardiac surgery are admitted to the monitoring room with tracheal intubation. In addition to observing the color of the child’s face, lips and extremities, we should also listen to the breath sounds of both lungs, observe the chest movement, do blood gas analysis every 15 minutes, and then use the ventilator at high speed according to the blood gas results. Properly fix the tracheal intubation. 2)
According to the inner diameter of the intubation tube, choose a suction tube with a certain hardness and smoothness whose outer longitude is 1/2 of it after sterilization and use it for suctioning in the tracheal intubation tube, pressurized awe-assisted breathing with pure oxygen 5~10 times before and after each suction, use saline 0.5~2ml for each rinse, and aseptic operation with disposable non-toxic polyethylene film gloves is ideal. Due to the anatomical and physiological characteristics of the respiratory system of pediatric patients described earlier, pay attention to gentle movements during suctioning operation, otherwise it will easily lead to injury and bleeding. Each aspiration should be controlled within 5 seconds to prevent hypoxia in the patient. 3) Regular chest physiotherapy (position changes, chest and back tapping, and simultaneous chest compressions for infants) facilitates the expulsion of airway secretions. 4) When the child has stable cardiac function, no serious heart rhythm disturbance, good cough and spontaneous respiration, no large amount of grip tube shunt
When the child has stable cardiac function, no serious heart rhythm disturbance, good cough and spontaneous respiration, no large amount of grip tube, no abnormal activity bleeding, normal range of arterial blood gas analysis, consciousness, and no serious system complications, extubation can be considered. 3. Cardiac function monitoring 1)
Pulse: After cardiac surgery, the patient should be immediately connected to a cardiac monitor in the monitoring room, closely observe the heart rhythm, heart rate, generally according to the age of the heart rate control at 100 ~ 140 times / min, the monitoring room nurse should be able to identify a variety of common heart rhythm disorders graphics, such as hair degree, need to be recorded in a timely manner, to inform the doctor on duty to deal with, and should often observe the unperipheral circulation of the extremities, the skin temperature and color. 2)
Blood pressure and cardiac chamber manometry tube: At present, open or closed arterial puncture tube diameter transducer is connected to pressure monitor in cardiac surgery, and cardiac chamber manometry tube is also connected to the corresponding transducer input pressure monitor, pay attention to distinguish various pressure waveforms, keep the pressure tube unobstructed, use 5% glucose water or 0.9% saline 500ml with heparin 500μ per hour 2ml continuous input by micro pump, so that The manometry tube is not blocked. At the same time, care must be taken to securely fix and keep all transducers (i.e., pressure receptors) at the atrial level for accurate data. For some cardiac function is not away from the use of antihypertensive drugs children should pay more attention to the relationship between the concentration of antihypertensive drugs, drip speed and blood pressure, in each change of the storage syringe of antihypertensive drugs, the action should be particularly agile, often small children, poor cardiac function of children are particularly sensitive, when the blood pressure fluctuations are large and fast. At this time, it is necessary to monitor closely and record in a timely manner. Each pressure tube needs to be calibrated to zero position every shift, and also to keep the correct data in a way that reduces errors. 4. Basic care 1) Decubitus ulcers: Since cardiac surgery is done under hypothermic or deep hypothermic conditions, the interstitial edema and cold swelling of the tissues of the sick child after extracorporeal circulation, coupled with the fact that the child is bedridden for a long time back in the care unit, makes it very easy for decubitus ulcers to occur at the site of pressure. In the care, attention should be paid to.
A. Sleep on a sponge bed or water bed to keep the area light, soft and comfortable. B. Turn regularly to reduce local pressure time. C. Give alcohol massage to the pressurized area. 2) Skin: The skin of children and infants is delicate, and skin disinfection before surgery is routinely done with iodine, which is highly irritating and prone to skin burns. 3) Oral cavity: post-operative cardiac children just suffered the surgical blow, while for the prevention of bacterial infection often with high doses of antimicrobial agents, while the tracheal intubation time is longer, so the sick children are very vulnerable to oral cavity of the toxin infection. Therefore, for nasal intubation or indwelling gastric tube need to be oral care twice a day, do not give or give less sweet drinks. For those with mycobacterial infections, mycobacterium 100,000 mu can be applied to the oral cavity 3 times a day. Post-operative care for children with precocious heart disease is very important, 1 to 3 months after surgery, parents should pay attention to the child’s physical condition, according to medical advice to the child’s wound care, take medication on time, regular review, pay attention to the amount of food and drink and urine volume to balance, weight should not increase too quickly, if there is discomfort, promptly to the hospital.