采用生物电抗技术监测儿童连续血液净化对血流动力学的影响

Noninvasive cardiac output monitoring using bioreactance in pediatric continuous blood purification patients

目的采用生物电抗无创心输出量监测(non-invasive cardiac output monitoring,NICOM)技术研究儿童连续血液净化(continuous blood purification,CBP)对血流动力学的影响。方法自2014年3月始前瞻性收集同意参与研究的行CBP的病例。CBP开始前连接Cheetah Medical无创心排量检测仪。测定基础血流动力学参数及治疗过程中各项生命体征和血流动力学参数的变化。结果自2014年3月至2016年12月共纳入21例患儿(最小1.0岁,最大15.5岁),收集69例次CBP的血流动力学数据。治疗前基础心指数(cardiac index,CI)为3.4(2.4,6.1)L/(min·m^2),每搏输出量指数(stroke volume index,SVI)为43(26,75)ml/(m^2·beat)。治疗初始的平均动脉压(mean arterial pressure,MAP)、CI及SVI均呈下降趋势,而心率上升。开始治疗6~10min的平均CI及SVI均低于基础值,差异具有统计学意义(P<0.001)。在治疗过程中,CI及SVI(均每4小时取值1次)分别为3.0(2.4,4.6)L/(min·m^2)和28(21,57)ml/(m^2·beat)。治疗结束时CI为3.4(2.5,5.3)L/(min·m^2),与基础CI无统计学差异(P=0.073),而治疗结束时SVI为35(25,67)ml/(m^2·beat),高于过程SVI,但仍低于基础SVI,差异有统计学意义(P<0.05)。结论CI及SVI在CBP初始持续下降,并在整个治疗过程中持续处于较低水平,回血结束后CI可恢复至治疗前水平,SVI仍未恢复。

Objective To study the influence of continuous blood purification(CBP) on cardiac output of pediatric patients using bioreactance. Methods Patients underwent CBP in PICU and nephrology ward from March 2014 were prospectively enrolled after approval by ethics committee.CBP therapies were all performed by Fresenius Medical Care hemodialysis machine.Cardiac output values were obtained using the non-invasive cardiac output monitoring(NICOM) device (Cheetah Medical). Blood pressure, heart rate, cardiac index(CI) and stroke volume index(SVI) were recorded before the therapy, at the beginning of therapy, during the course of therapy, and at the end of each therapy. Results Twenty-one pediatric patients (from 1.0 year to 15.5 years) were recruited and 69 treatments were recorded from March 2014 to December 2016.The basic CI was 3.4 (2.4, 6.1) L/(min·m^2), basic SVI was 43 (26, 75) ml/(m^2·beat). During the beginning of therapy, mean arterial pressure(MAP), CI and SVI all dropped from the baseline (P<0.001), whereas heart rate increased.During the course of CBP, CI and SVI (were both recorded every 4 hours) kept on dropping and stayed at a relatively lower level.Course CI was 3.0 (2.4, 4.6) L/(min·m^2) and course SVI was 28 (21, 57) ml/(m^2·beat). At the end of therapy, CI was 3.4 (2.5, 5.3) L/(min·m^2), with no significant difference from the baseline CI (P=0.073). However, the SVI at the end of therapy was 35 (25, 67) ml/(m^2·beat), higher than the course SVI but still lower than the basic SVI, the differences were statistically significant (P<0.05). Conclusion CI and SVI continue to decline at the beginning of CBP treatment and remain at a lower level throughout the course of treatment.After the therapy, CI has returned to the basic level whereas SVI has not recovered.