电子心力监测法在危重患儿心功能监测中的应用

Application of electric impedance in monitoring cardiac function of pediatric critically ill patients

目的探讨电子心力监测法(ICON)与超声心动图(ECHO)两种无创心功能监测方法监测危重患儿心功能的相关性及一致性。方法选取2020年1月—2021年3月在重症医学科进行治疗的53例患儿,同时使用ECHO和ICON进行心功能监测,并记录每博量(SV)和心排血量(CO),比较两种方法监测心功能的相关性及一致性。结果53例患儿中男37例、女16例,年龄15.0(5.1~63.0)月。ICON与ECHO测量的SV、CO差异均无统计学意义(P>0.05),存在正相关关系(r=0.91、0.85,P均<0.001);ICON和ECHO两种方法监测的SV和CO的一致性好,其组内相关系数(ICC)分别为0.89和0.87(P均<0.001)。采用Bland-Altman法进行一致性分析,ECHO与ICON监测的SV差值平均值为2.29 mL,一致性区间为-17.02~21.60 mL;CO差值的平均值为0.27 mL,一致性区间为-1.83~2.36 mL。使用呼吸机时两种方法测得的SV和CO的相关系数分别为0.88和0.82(P均<0.001),ICC值分别为0.86和0.87(P均<0.001);未使用呼吸机时测得的SV和CO的相关系数分别为0.89和0.89(P均<0.001),ICC值分别为0.91和0.86(P均<0.001)。结论危重患儿ICON与ECHO监测心功能一致性及相关性均好,且不受使用呼吸机的影响,在儿童重症监护中有一定的应用价值。

Objective To investigate the correlation and consistency of electric impedance(ICON)and echocardiography(ECHO)in monitoring the heart function of pediatric critically ill patients.Methods A total of 53 children treated in the intensive care unit from January 2020 to March 2021 were recruited.ECHO and ICON were used to monitor cardiac function,and stroke volume(SV)and cardiac output(CO)were recorded to compare the correlation and consistency between the two methods.Results A total of 53 children(37 boys and 16 girls)were included,with a median age of 15.0(5.1-63.0)months.There was no statistically significant difference in SV and CO measured by ICON and ECHO(P>0.05),and there was a significantly positive correlation(r=0.91 and 0.85,both P<0.001).The consistency of SV and CO monitored by ICON and ECHO was good,and the intra-class correlation coefficients(ICC)were 0.89 and 0.87,respectively(P<0.001).Bland-altman method was used for consistency analysis.The average SV difference between ECHO and ICON was 2.29 mL,and the consistency interval was-17.02-21.60 mL.The average difference of CO monitored by ECHO and ICON was 0.27mL,and the consistency interval was-1.83-2.36mL.Under the condition of using ventilator,the correlation coefficients of SV and CO measured by the two methods were 0.88 and 0.82(both P<0.001),and the ICC values were 0.86 and 0.87(both P<0.001).The correlation coefficients of SV and CO measured by the two methods without using the ventilator were 0.89 and 0.89(both P<0.001),and the ICC values were 0.91 and 0.86(both P<0.001).Conclusions ICON and ECHO have good consistency and correlation in monitoring the cardiac function of critically ill children,and are not affected by the use of ventilators.Therefore,they have certain application values in pediatric intensive care.