探讨胸腔镜膈疝修补术治疗新生儿先天性膈疝对围手术期监测、护理方法的影响。

选取2015年10月至2019年10月如皋市人民医院收治的先天性膈疝新生儿48例，分为观察组和对照组。观察组患儿行胸腔镜膈疝修补术并行围手术期监测护理，对照组患儿行传统开放手术。术中严密监测患儿血气指标，重点观察动脉血二氧化碳分压（PaCO₂）、pH、乳酸等指标的变化。

全部患儿顺利完成手术。试验组和对照组患儿手术时间分别为（118.51±18.75）min和（135.13±30.19）min，差异有统计学意义（P<0.05）；观察组和对照组术中PaCO₂、pH、乳酸分别为[（49.00±9.36）比（38.12±4.34）]mmHg、[（7.26±0.26）比（7.39±0.16）]、[（0.87±1.41）比(0.63±0.86）]mmol/L，差异均有统计学意义（P<0.05）；观察组和对照组术后机械通气时间分别为[（47.39±10.32）比（117.81±19.63）]h，差异有统计学意义（P<0.05）；观察组术后并发气胸2例，胸腔积液1例，对照组术后并发气胸5例，胸腔积液2例，差异有统计学意义（P<0.05）。2组患儿随访9～13个月，随访期间无复发、死亡的病例。

胸腔镜治疗新生儿先天性膈疝治疗效果肯定，但会增加围手术期护理难度，在保证护理监测质量的前提下，能够降低术后并发症发生率及死亡率。

To investigate the effect of thoracoscopic diaphragmatic hernia repair for neonates with congenital diaphragmatic hernia on perioperative monitoring and nursing methods.

A total of 48 neonates with congenital diaphragmatic hernia admitted to Rugao People's hospital from October 2015 to October 2019 were selected and divided into observation group and control group. The children in the observation group received thoracoscopic diaphragmatic hernia repair and perioperative monitoring and nursing, while the children in the control group received traditional open surgery. Blood gas indexes were closely monitored during the operation, with emphasis on the changes of arterial blood partial pressure of carbon dioxide (PaCO₂), pH, lactic acid and other indexes.

All cases successfully completed the operation. The operative time of the experimental group and the control group was (118.51±18.75) minutes vs (135.13±30.19) minutes, respectively, and the difference was statistically significant (P<0.05). Intraoperative PaCO₂, pH and lactic acid in the observation group and the control group were (49.00±9.36) mmHg vs (38.12±4.34) mmHg, (7.26±0.26) vs (7.39±0.16), (0.87±1.41) mmol/L vs (0.63±0.86) mmol/L, respectively, the differences were statistically significant (P<0.05). The duration of mechanical ventilation was (47.39±10.32) hours in the observation group and (117.81±19.63) hours in the control group, respectively, and the difference was statistically significant (P<0.05). The observation group had postoperative pneumothorax in 2 cases and pleural effusion in 1 case, and the control group had postoperative pneumothorax in 5 cases and pleural effusion in 2 cases, the difference being statistically significant (P<0.05). Two groups of children were followed up for 9-13 months. During the follow-up, there was no recurrence or death.

The therapeutic effect of thoracoscopic treatment of neonatal congenital diaphragmatic hernia is certain, but it will increase the difficulty of perioperative nursing, and on the premise of ensuring the quality of nursing monitoring, the incidence of postoperative complications and mortality can be reduced.