探究胸腔镜治疗新生儿先天性膈疝（CDH）的围手术期监护护理效果。

选取2010年1月至2018年10月，首都医科大学附属北京潞河医院就诊的64例先天性膈疝患儿，随机分为综合护理组（32例）和常规护理组（32例），常规护理组给予围手术期常规护理，综合护理组则在此基础上给予综合护理。分别观测并比较2组患儿的围手术期指标、血气分析指标、舒适度、依从性以及护理质量评分和术后并发症发生情况。

综合护理组患儿的手术时间、术中出血量分别为（114.29±11.54）min、（2.58±1.01）ml与常规护理组（116.83±12.73）min、（2.81±1.03）ml比较，差异无统计学意义（t=0.862、0.900，P=0.392、0.356）；综合护理组住院时间、术后机械通气时间（12.18±4.11）d、（2.04±1.17）d均低于常规护理组（17.52±5.25）d、（2.89±2.03）d，差异均有统计学意义（t=4.670、2.115，P<0.001、=0.038）。2组患儿血气指标在术前、气腹后10 min、放气后30 min 3个时间点组间比较，差异均无统计学意义（P>0.05）。气腹后10 min与术前比较，2组患儿组内PaCO₂、气道峰压、呼气末CO₂分压均增加，差异均有统计学意义（P<0.05）；放气后30 min与术前比较，2组患儿的PaCO₂、气道峰压、呼气末CO₂分压均差异无统计学意义（P>0.05）。综合护理组患儿的舒适度、依从性和护理质量评分分别为（91.05±10.22）分、（91.48±7.64）分和（93.11±10.08）分均高于常规护理组（81.69±9.81）分、（80.27±7.05）分和（80.97±8.19）分，差异均有统计学意义（t=3.853、6.288、5.450，P均<0.001）。综合护理组术后并发症的发生率（3.125%）低于常规护理组（21.875%），差异有统计学意义（χ²=5.143，P=0.023）。

综合护理干预在胸腔镜膈疝修补术治疗新生儿CDH中具有重要作用，可明显缩短患儿术后恢复时间，使血气指标维持正常平稳，有效降低术后并发症的发生率，显著提高患儿的舒适度、依从性和护理满意度，值得临床推广。

To explore the effect of perioperative monitoring and nursing in the treatment of neonatal congenital diaphragmatic hernia (CDH) by thoracoscopic repair of diaphragmatic hernia.

64 children with CDH who were treated in Beijing Luhe hospital from January 2010 to October 2018 were randomly divided into the comprehensive nursing group (32 cases) and the routine nursing group (32 cases). The routine nursing group was given routine perioperative nursing, while the comprehensive nursing group was given comprehensive nursing on the basis of routine perioperative nursing. The perioperative indicators, blood gas analysis indicators, the scores of comfort, compliance, nursing quality and complications were observed and compared between the two groups.

There was no significant difference in operation time and bleeding volume between the comprehensive nursing group and the routine nursing group (114.29±11.54 min vs 116.83±12.73 min; 2.58±1.01 ml vs 2.81±1.03 ml, P>0.05), while the hospitalization time and mechanical ventilation time after operation in the comprehensive nursing group were lower than those in the routine nursing group (12.18±4.11 d vs 17.52±5.25 d; 2.04±1.17 d vs 2.89±2.03 d; P<0.05). There was no significant difference in blood gas between the two groups at three time points of pre-operation, 10 minutes after pneumoperitoneum and 30 minutes after deflation (P>0.05). Compared with pre-operation, 10 minutes after pneumoperitoneum, the levels of PaCO₂, peak airway pressure and end-expiratory CO₂ pressure increased in both groups (P<0.05). While there was no significant difference in PaCO₂, peak airway pressure and end-expiratory CO₂ pressure between the two groups when comparing pre-operation and 30 minutes after deflation (P>0.05). The scores of comfort (91.05±10.22), compliance (91.48±7.64) and nursing quality of children (93.11±10.08) in comprehensive nursing group were higher than those in routine nursing group (81.69±9.81, 80.27±7.05, and 80.97±8.19, P<0.05). The incidence of postoperative complications in the comprehensive nursing group (3.125%) was lower than that in the conventional nursing group (21.875%) (P<0.05).

Comprehensive nursing intervention plays an important role in the treatment of neonatal CDH by thoracoscopic diaphragmatic herniorrhaphy. It can significantly shorten the recovery time after operation, keep the blood gas index normal and stable, effectively reduce the incidence of complications after operation, and significantly improve the comfort, compliance and nursing satisfaction of children. It is worthy of clinical promotion.