连续多普勒无创血流动力学监测在早产儿出生早期血流动力学变化中的应用

Application of continuous Doppler noninvasive hemodynamic monitoring to observing early postnatal hemodynamic changes in premature infants

目的:应用连续多普勒无创血流动力学监测系统探索早产儿出生后早期血流动力学变化特点。方法:选择2021年8月~2022年4月我院收治的117例早产儿及同期出生的34例足月儿,应用连续多普勒无创血流动力学监测系统监测出生后第1~7天(PD1、PD2、PD3、PD4、PD5、PD6、PD7)主动脉区每搏输出量(SV)、心输出量(CO)、心脏指数(CI)、外周血管阻力(SVR)、外周血管阻力指数(SVRI)、肌力指数(INO)。按胎龄分为早产儿组[<37周,A组(A1组<32周、A2组32~34周、A3组34~37周)]和足月儿组(≥37周,B组),比较早产和足月组新生儿血流动力学指标及其在早产儿间的差异。结果:早产儿组前7天SV、前7天CO、第1~4、6~7天INO水平均低于足月儿对照组(P<0.05);A3组前7天SV均大于A1、A2组(P<0.05),A2组第6天SV大于A1组(P<0.05);A3组前7天CO大于A1组(P<0.05),第1~3、5~7天CO大于A2组(P<0.05);A2组第6天CO大于A1组(P<0.05)。结论:早产儿早期血流动力学变化相对较大,且和胎龄相关,并可通过无创血流动力学监测系统进行有效监测。

Objective:To observe the picture of early hemodynamic changes in postnatal premature infants using continuous Doppler noninvasive hemodynamic monitoring system.Methods:One hundred and seventeen preterm infants admitted to our hospital between August 2021 and April 2022 were included,and another 34 full-term infants born in the corresponding period were recruited to undergo monitoring of aortic hemodynamic changes,including the myocardial parameters of stroke volume(SV)index,cardiac output(CO),cardiac index(CI),systemic vascular resistance(SVR),systemic vascular resistance index(SVRI)and inotropy(INO)using continuous Doppler noninvasive hemodynamic monitoring system in 7 days after birth(PD1,PD2,PD3,PD4,PD5,PD6 and PD7).All infants were divided into group A1(<32W),group A2(32W-34W),group A3(34W-36W)and group B(Full-term infants,≥37 W)according to the gestational age.Then the difference in hemodynamics was compared among groups.Results:The levels of SV(7 days),CO(7 days)and INO(day 1-4;day 6-7)were significantly lower in premature infants than in full-term infants(all P<0.05).The SV in the first 7 days was obviously greater in group A3 than in group A1 and A2(all P<0.05),and the SV at day 6 was greater in group A2 than in group A1(P<0.05).Infants in group A3 had significantly higher CO in the first 7 days than those in the group A1,and higher CO at day 1-3 and day 5-7 than those in group A1(all P<0.05).Conclusion:The hemodynamic changes in early premature infants are relatively large and related to gestational age,and can be effectively monitored by non-invasive hemodynamic monitoring system.