电子心力测量法在先天性心脏病患儿术后监护中的临床应用

Clinical application of electrical cardiometry in postoperative monitoring of children patients with congenital heart disease

目的探讨电子心力测量法(EC)在先天性心脏病(CHD)患儿术后监护中的临床意义。方法选取2019年12月至2020年6月在重庆医科大学附属儿童医院接受CHD手术并于术后转入ICU的患儿117例为研究对象。选取17例患儿分别采用EC及经胸超声心动图(TTE)进行每搏射血量(SV)、每搏变异度(SVV)、下腔静脉扩张指数(dIVC)测定。选取100例患儿分为EC组和常规组,每组50例;常规组根据常规监测指标及临床经验进行治疗,EC组在常规组基础上,采用EC监测患儿术后0、8、16、24 h的心脏指数(CI)、SVV、外周血管阻力指数(SVRI)。记录两组患者机械通气时间、ICU停留时间、术后24 h乳酸清除率,术后24 h血管活性药物评分均值(VIS_(24mean))、最大值(VIS_(24max)),术后24 h单位体重液体净入量、严重病情结局。结果EC与TTE所测SV呈明显正相关(r=0.932,P<0.01),测得SV差值的均值与一致性区间为(-0.29±3.32)mL,平均百分误差28.78%,一致性较好;EC测得SVV与TTE测得dIVC呈正相关(r=0.517,P<0.05)。EC组患儿机械通气时间、ICU停留时间均短于常规组,24 h单位体重液体净入量、低心排综合征发生率、严重病情结局发生率低于常规组(P<0.05)。两组患儿24 h乳酸清除率、血管活性药物评分,腹膜透析、心肺复苏及死亡比例未见明显差异(P>0.05)。结论采用EC监测对CHD术后治疗具有一定临床价值。

Objective To explore the clinical significance of electrical cardiometry(EC)in postoperative monitoring of children patients with congenital heart disease(CHD).Methods One hundred and seventeen children patients receiving the CHD surgery and transferring to ICU after operation in the Affiliated Children′s Hospital of Chongqing Medical University from December 2019 to June 2020 were selected as the study subjects.Seventeen cases were selected to adopt EC and transthoracic echocardiography(TTE)to detect the stroke volume(SV),stroke volume variation(SVV)and the distensibility index of the inferior vena cava(dIVC).Other 100 children cases were selected and divided into the EC group and routine group,50 cases in each group.The routine group was treated according to the routine monitoring indicators and clinical experience,while on the basis of the routine group,the EC group adopted EC to monitor the cardiac index(CI),SVV and systemic vascular resistance index(SVRI)at postoperative 0,8,16,24 h.The mechanical ventilation time,ICU stay time,lactic acid clearance rate at postoperative 24 h,VIS_(24mean) at postoperative 24 h,VIS_(24max),net fluid intake per unit body weight at postoperative 24 h and severe disease outcome were recorded in the two groups.Results EC had significantly positive correlation with SV measured by EC(r=0.932,P<0.01);the mean value of detected SV difference value and the consistency interval were(-0.29±3.32)mL,the average percentage error was 28.78%with good consistency.SVV measured by EC was positively correlated with dIVC measured by TTE(r=0.517,P<0.05).The use time of breathing machine and ICU stay time in the EC group were shorter than those in the routine group.The 24 h net fluid volume intake per unit body weight,incidence rate of low cardiac output syndrome and severe disease outcome in the EC group were lower than those in the routine group(P<0.05).The 24 h lactic acid clearance rate,vasoactive drug score,peritoneal dialysis,cardiopulmonary resuscitation and mortality rate had no significant differences between the two groups(P>0.05).Conclusion Adopting the EC monitoring has a certain clinical value for postoperative treatment of CHD.