运用无创容量指标评价儿童先天性心脏病术后液体反应性

Application of Non-invasive Volume Parameters to Prediction of Fluid Responsiveness in Children Undergoing Congenital Heart Surgery

目的运用连续多普勒超声心排量监测仪(ultrasonic cardiac output monitor,USCOM)对先天性心脏病(先心病)术后患儿液体治疗前后进行血流动力学监测,比较血流动力学指标如中心静脉压(central venous pressure,CVP)、每搏量变异度(stroke volume variation,SVV)、校正血流时间(corrected flow time,FTc)及肌力指数(smith madigan inotropy index,SMII)等预测先心病术后患儿液体反应性的准确性。方法应用USCOM对先心病术后患儿进行液体治疗前后血流动力学的监测。根据液体治疗前后的每搏输出量指数(stroke volume index,SVI)计算每搏输出量指数变化率(ΔSVI),根据正性肌力药物的使用情况计算出正性肌力药物评分(inotropic scores,IS)。定义液体治疗后ΔSVI≥15%为液体治疗有反应组,<15%为液体治疗无反应组;根据正性肌力药物的使用情况分亚组:IS≤10组及IS>10组。结果 (1)全部患儿中仅SVV的ROC曲线下面积(area under the ROC curve,AUC)具有评估液体反应性的价值(AUC为0.776,P<0.01);(2)亚组中:IS≤10组及IS>10组中也表现为仅SVV的AUC具有评估液体反应性的价值(AUC分别为0.732,P<0.05及0.813,P<0.01)。结论 (1)用USCOM监测的SVV可以预测先心病术后的液体反应性,而CVP、FTc及SMII均不能准确预测先心病术后的液体反应性;(2)亚组中,IS>10组SVV预测液体反应性的准确性要高于IS≤10组。

Objective To use ultrasonic cardiac output monitor（USCOM）to monitor the hemodynamics of children who underwent congenital heart disease（CHD）surgery before and after fluid therapy,and to examine the accuracy of the hemodynamic parameters central venous pressure（CVP）,stroke volume variation（SVV）,corrected flow time（FTc）and smith madigan inotropy index（SMII）in predicting fluid responsiveness of children post operation.Methods USCOM was used to monitor the hemodynamic parameters of post-operative children before and after fluid therapy.The change of SVI（ΔSVI）was calculated based on the stroke volume index（SVI）before and after fluid therapy,and the inotropic scores（IS）were obtained based on the doses of inotropic drugs used.Children withΔSVI≥15% were defined to be responders who responded to fluid resuscitation and those withΔSVI15% as non-responders.Two subgroups were also established in terms of IS：IS≤10 group and IS10group.Results Among the parameters（CVP,FTc and SM,etc.）,only the area under the ROC curve（AUC）of SVV was significantly different between before and after fluid therapy（AUC 0.776,P0.01）.Subgrouping analysis also showed significant difference in only the AUC of SVV between IS≤10group and IS10group（AUC：0.732,P=0.045 or 0.813,P=0.002）.Conclusion SVV monitored by USCOM,in contrast to CVP,FTc and SMII,can predict the fluid responsiveness in children after congenital heart surgery.Prediction of fluid responsiveness by SVV shows higher accuracy in IS10group than in IS≤10group.