To Construct And Apply Early Graded Rehabilitation Nursing Model For Children With Congenital Heart Disease After Surgery

Background:Congenital heart disease is one of the most common congenital malformations,which has become a major public health problem affecting children’s health and quality of life.At present,children with congenital heart disease are treated with surgical operations.With the development of medical technology,the survival rate of children after surgery is constantly improving,but there is a lack of standardized model to promote functional recovery after surgery,and the surgical trauma will also bring negative effects on children.Cardiac rehabilitation has a positive effect on cardiovascular disease,which can reduce the recurrence rate and mortality,relieve anxiety and depression,and improve quality of life.At present,the relevant research in our country is mostly concentrated in the adult field,and there is no normative rehabilitation nursing program for children with congenital heart disease.Pediatric Intensive Care Unit Up ! has been proved to have positive benefits for critically ill children with all disease types in the Pediatric Intensive Care Unit.However,due to the particularity of children with congenital heart disease,it is necessary to learn from this model and further improve it,so as to develop a set of standardized early rehabilitation nursing model for children with congenital heart disease after surgery,in order to promote the recovery of body function and improve the quality of life.Objective:To improve the early graded rehabilitation nursing model suitable for children with congenital heart disease after surgery,explore the feasibility of early graded rehabilitation nursing model for children with congenital heart disease after surgery and evaluate its effect.To standardize the process of postoperative rehabilitation nursing for children with congenital heart disease and provide evidence for clinical work.Methods:The study was divided into two parts.In part one,through a systematic literature review,qualitative interview and PICU UP!model to sort out the rehabilitation nursing plan for children with congenital heart disease,and initially formed the rehabilitation nursing model for children with congenital heart disease after surgery.Then Delphi expert letter consultation,combined with expert advice to modify,finally formed the early postoperative graded rehabilitation nursing model for children with congenital heart disease.In part two,116 children with congenital heart disease who underwent surgical operations from August 2022 to January 2023 were selected.According to the admission time,the children were divided into control group and intervention group,58 patients in each group.The control group received routine rehabilitation nursing,and the intervention group received improved early graded rehabilitation nursing model.The number of children reaching the target function,PICU residence time and total hospital stay in the two groups were calculated and recorded,and the motor development ability and adverse events of the children were assessed at discharge.Results:1.The improved early graded rehabilitation nursing model for children with congenital heart disease after surgery includes 4 first-level items,15 second-level items and 48 third-level items.The 4 first-level items are the evaluation of the early graded rehabilitation nursing model,the grading standard of the early graded rehabilitation nursing model,the implementation of the early graded rehabilitation nursing model,the effect evaluation and health education.2.There were no significant difference in demographic data and clinical disease-related data between the two groups of patients(P>0.05).3.The number of children in the intervention group who achieved the target function with higher difficulty was higher than those in the control group at the time of PICU transfer and discharge,and the difference was statistically significant(P<0.05).4.At 3 months to 3 years old,Gross Motor Quotient(GMQ),Fine Motor Quotient(FMQ)and Total Motor Quotient(TMQ)scores in the intervention group were higher than those in the control group.The differences in GMQ and TMQ were statistically significant(P<0.05),while the difference in FMQ was not statistically significant(P>0.05).5.When the children aged 3-14 years were discharged from hospital,the six-minute walking test(6MWT)in the intervention group were longer than those in the control group.The differences were statistically significant in the 3-6 years and 7-10 years old groups(P<0.05),but not in the 11-14 years old group(P>0.05).6.There was no significant difference in PICU residence time between the two groups(P>0.05),which was(122.48±46.00)h in the intervention group and(133.66166.70)h in the control group.The difference of total hospital stay was statistically significant(P<0.05),which was(16.601±5.14)d in the intervention group and(20.69± 12.95)d in the control group.Conclusion:1.The early postoperative graded rehabilitation nursing model for children with congenital heart disease is scientific,safe and feasible.2.The circulatory system,respiratory system and nervous system were evaluated in children with congenital heart disease 24 hours after returning to PICU after surgery.If all vital signs were stable and there were no contraindications,rehabilitation nursing model was suitable for children with congenital heart disease.3.Early graded rehabilitation nursing model can help children with congenital heart disease achieve more difficult target functions.4.Early graded rehabilitation nursing model can improve the motor development ability and shorten the length of hospital stay in children with congenital heart disease.