电子心力测量法对危重早产儿心功能减退的诊断价值研究

The diagnostic values of electronic cardiometry for cardiac function monitoring in critically ill preterm infants

目的探讨电子心力测量(electronic cardiometry,EC)法对危重早产儿心功能减退的诊断价值。方法前瞻性选择2023年1~8月新疆医科大学第一附属医院新生儿重症监护室收治的危重早产儿,根据超声心动图结果分为心功能减退组和心功能正常组,比较两组EC法测定的心输出量(cardiac output,CO)、每搏输出量(stroke volume,SV)、心脏指数(cardiac index,CI)、心肌收缩力(index of contractility,ICON)、左室射血时间(left ventricular ejection time,LVET)、胸腔液体容量(thoracic fluid content,TFC)、外周血管阻力(systemic vascular resistance,SVR)。绘制EC法测定不同血流动力学指标诊断危重早产儿心功能减退的受试者工作特征曲线,并验证其诊断价值。结果共纳入138例,心功能减退组36例,心功能正常组102例。心功能减退组CO、SV、CI、ICON、LVET低于心功能正常组,TFC高于心功能正常组(P均<0.05),两组SVR差异无统计学意义(P>0.05)。受试者工作特征曲线显示CO、SV、CI、ICON、LVET诊断危重早产儿心功能减退的曲线下面积分别为0.718(95%CI 0.608~0.828)、0.790(95%CI 0.699~0.882)、0.875(95%CI 0.779~0.935)、0.786(95%CI 0.694~0.878)、0.890(95%CI 0.829~0.952);最佳临界值分别为0.47 L/min、4.02 ml、2.86 L/(min·m^(2))、119.85、140 ms;灵敏度依次为63.9%、86.1%、86.1%、77.8%、86.1%,特异度依次为79.4%、66.7%、78.4%、70.6%、77.5%。结论EC法可有效监测危重早产儿血流动力学指标,对于诊断危重早产儿心功能减退有一定的临床价值。

Objective To study the diagnostic values of electronic cardiometry(EC)for cardiac function monitoring in critically ill preterm infants.Methods From January 2023 to August 2023,critically ill preterm infants admitted to NICU of our hospital were prospectively enrolled and assigned into two groups based on echocardiographic results:decreased cardiac function group(decrease group)and normal cardiac function group(normal group).The following parameters were compared between the two groups:cardiac output(CO),stroke volume(SV),cardiac index(CI),index of contractility(ICON),left ventricular ejection time(LVET),thoracic fluid content(TFC)and systemic vascular resistance(SVR).The receiver-operating characteristic(ROC)curve was drawn to compare the diagnostic values of different hemodynamic parameters for cardiac function monitoring.Results A total of 138 infants were enrolled,including 36 in decrease group and 102 in normal group.Decrease group showed significantly lower parameters including CO,SV,CI,ICON and LVET,while higher TFC than normal group(all P<0.05).No significant difference existed in SVR between the two groups(P>0.05).ROC curves revealed that area-under-curve(AUC)for CO,SV,CI,ICON and LVET in diagnosing cardiac decompensation in critically preterm infants were 0.718(95%CI 0.608-0.828),0.790(95%CI 0.699-0.882),0.875(95%CI 0.779-0.935),0.786(95%CI 0.694-0.878)and 0.890(95%CI 0.829-0.952)with optimal cut-offs to be 0.47 L/min,4.02 ml,2.86 L/(min·m^(2)),119.85 and 140 ms,respectively.The sensitivities were 63.9%,86.1%,86.1%,77.8%and 86.1%.The specificities were 79.4%,66.7%,78.4%,70.6%and 77.5%.Conclusions EC method can effectively monitor hemodynamic parameters and is helpful determining cardiac function in critically ill preterm infants.