无创心排量监测联合被动抬腿预测小儿先天性心脏病术后容量反应性的研究

Clinical observation of non-invasive cardiac output monitoring combined with passive leg raising to predict fluid responsiveness in infants undergoing congenital heart surgery

目的 探讨无创心排量监测联合被动抬腿预测小儿先天性心脏病患儿术后容量反应性的作用.方法 选择2015年5月至2016年4月入住解放军第九四医院ICU的小儿先天性心脏矫治术后需要扩容的患儿纳入本研究,按四步进行.第一阶段,45°半卧位;第二阶段,躯体平躺脚45°位;第三阶段,45°半卧位;第四阶段,45°半卧位进行10 min内静脉输注10ml/kg 6％羟乙基淀粉进行扩容.通过床旁超声连续进行四阶段心输出量（CO）和每搏输出量（SV）监测,根据扩容后SV的变化值△SV是否≥10％分为反应组和无反应组,受试者工作特征曲线（ROC curve）评价PLR所致△SV预测容量反应性的价值.结果 48例需要扩容的患儿纳入本研究,8例因不能得到满意的床旁超声多普勒信号被排除,26例（65.0％）患儿PLR所致△SV≥10％为反应组,△SV曲线下面积AUC为0.85±0.06,△SV≥10％预测容量反应性的敏感度和特异度分别为80.77％和64.29％,阳性预测值和阴性预测值分别是80.77％和64.29％.结论 通过无创心排量监测联合被动抬腿所致△SV对评估小儿先天性心脏术后患儿容量反应性具有一定的指导意义.

Objective To explore the value of non-invasive cardiac output monitoring combined with pas- sive leg raising to predict fluid responsiveness in infants undergoing cardiac surgery. Methods From May 2015 to May 2016, 48 infants undergoing cardiac surgery requiring fluid expansion were studied in four phases： Step 1： with upper body parts being 45° higher, Step 2：the upper parts of the body were then lowered to achieve a hori- zontal position with the lower limbs being raised 45°, Step 3： the patient was then placed back in the initial posi- tion（the upper parts being 45° higher） for 10 min, Step 4： a bolus of intravenous fluid challenge was given to the patient using 10 ml/kg of 6% Hydroxyethyl starch. Measuring stoke volume（SV ） and output（CO ） by using bedside Doppler eehocardiography device. Patients with an increase of SV ≥ 10% and SV〈10% induced by capacity fluid expansion were classified as responders and non-responders respectively. The role of PLR in predicting volume re- sponsiveness were evaluated by receiver operating characteristic curve（ROC curve）. Results 48 infants of congen- ital heart disease need fluid expansion were included, 8 patients were excluded because satisfactory Doppler signals could not been obtained. 26 （65.0%） patients were responders with an increase of SV≥ 10%, by using ROC curve analysis, the area under the curve was 0.85＋0.06 for SV≥ 10% induced by PLR. An increase in SV≥10% during PLR predictive volume responsiveness with a sensitivity of 80.77% and a specificity of 64.29%, positive predictive value of 80.77% and negative predictive value of 64.29%. Conclusion SV of PLR-induced changes in real time monitoring by non-invasive cardiac output monitoring device may be useful to predict volume responsiveness in infants undergoing cardiac surgery.