超声心输出量监测仪用于小儿室间隔缺损修补术后血流动力学监测的临床研究

Clinical study of echocardiographic cardiac output monitor for hemodynamic monitoring after repair of ventricular septal defect in children

目的使用超声心输出量监测仪(USCOM)对小儿室间隔缺损修补术后进行血流动力学的监测,了解术后心功能的变化情况.方法选取中国医科大学附属盛京医院小儿重症监护病房2017年1月至2018年3月行小儿室间隔缺损修补手术术后患儿24例,使用超声心输出量监测仪对手术后4个时间点的心脏指数(CI)、乳酸浓度(Lac)、中心静脉血氧饱和度(ScvO2)、心率(HR)、平均动脉压(MAP)记录.结果在术后4 h患儿CI达最高点6.5 L·min-1·(m2)-1,8 h达到最低点5 L·min-1·(m2)-1,24 h与1 h CI差异无统计学意义.ScvO2与CI具有相关性:1 h、4 h、8 h、24 h P值分别为0.003、0.02、0.034、0.03(均P<0.05),而与HR、MAP、Lac等指标无相关性(P>0.05),不能判断早期先天性心脏病术后患儿的心功能状况.结论USCOM是一种无创心排血量监测手段,可以一定意义上反映出室间隔缺损修补术后患儿心功能的变化.

Objective To monitor the hemodynamics of children with congenital heart disease after operation by using ultrosonic cardiac output monitor(USCOM)to understand the changes of cardiac function in children with congenital heart disease after operation.Methods Twenty-four children with congenital heart disease underwent operation in the pediatric intensive care unit of Shengjing Hospital Affiliated to China Medical University from January 2017 to March 2018 were selected.Cardiac index(CI),lactate(Lac)concentration,central venous oxygen saturation(ScvO2),heart rate(HR)and mean arterial pressure(MAP)were recorded at four time points after operation by USCOM.Results The CI reached the highest level of 6.5L·min-1·(m2)-1 in 4h,the lowest level of 5L·min-1·(m2)-1 in 8h,and the same level in 24h as that in 1h.ScvO2 was correlated with CI:P values of 1h,4h,8h and 24h were 0.003,0.02,0.034 and 0.03,respectively(all P<0.05),while ScvO2 was not correlated with HR,MAP and Lac(P>0.05),and could not be used to judge the cardiac function of children with early congenital heart disease after operation.Conclusion USCOM is a non-invasive method for monitoring cardiac output,which can reflect the changes of cardiac function in children with congenital heart disease after operation.