摘要
目的探讨床旁无创超声心输出量监测仪(USCOM)在指导新生儿胃肠道手术围手术期血流动力学管理中的应用价值。方法纳入2017年1月至2020年12月厦门市儿童医院新生儿科收治的胃肠道手术后发生血流动力学改变的新生儿75例,其中2017年1月至2018年12月非USCOM组34例,主要根据心率、血压、血气乳酸等临床指标评估术后患儿血流动力学状态;2019年1月至2020年12月USCOM组41例使用USCOM协助评估术后患儿血流动力学状态;另设40例为对照组,主要为病情稳定的新生儿高胆红素血症患儿。USCOM组及对照组使用USCOM检查,记录心排出量(CO)、心指数(CI)、外周血管阻力(SVR),对比USCOM组术前及术后、USCOM组与对照组CO、CI、SVR变化,对比USCOM组术前及术后心率、血压、乳酸变化,并比较分析USCOM组与非USCOM组血管活性药物剂量和术后首次使用时间、术后首次扩容时间、扩容量、术后24 h无尿或少尿发生率、住院时间。结果USCOM组术前CO、CI、SVR、心率、血压与对照组及术后12 h相比差异无统计学意义(P<0.05)。USCOM组术后1 h CO、CI较术前明显下降,乳酸较术前明显增高,差异均有统计学意义(P<0.05);USCOM组术后1 h SVR较术前增高,但差异无统计学意义(P>0.05)。USCOM组术后12 h CO、CI较术后1 h明显增高,SVR较术后1 h明显下降,差异均有统计学意义(P>0.05)。USCOM组术前及术后1 h心率、血压差异无统计学意义(P>0.05),术后12 h血压较术后1 h明显增高(P<0.05)。USCOM组比非USCOM组术后首次扩容时间及血管活性药物使用时间显著提前[0.75(0.50,1.37)h比7.00(5.00,13.25)h,Z=-7.041,P<0.001;(1.39±1.33)h比(8.61±5.15)h,t=-7.917,P<0.001],扩容总量显著减少[17.50(10.00,30.00)mL比30.00(20.00,30.00)mL,t=-3.045,P=0.002],多巴胺使用量显著减少[8.40(6.20,10.40)mg/kg比8.90(7.20,14.40)mg/kg,Z=-2.475,P=0.013],术后24 h少尿或无尿发生率明显减少(12.2%比32.3%,t=4.500,P=0.034),住院时间显著缩短[25.00(15.50,31.00)d比28.00(21.75,34.00)d,Z=-1.985,P=0.047],多巴酚丁胺及肾上腺素使用量无明显变化(P>0.05)。结论无创血流动力学监测可实时监测新生儿胃肠道围手术期血流动力学变化,有利于术后指导血管活性药物及液体的管理。
Objective To explore the value of ultrasonic cardiac output monitor(USCOM)in guiding perioperative hemodynamic management of neonatal gastrointestinal surgery.Methods Seventy-five neonates with hemodynamic changes after gastrointestinal surgery admitted to the Department of Neonatology,Xiamen Children′s Hospital from January 2017 to December 2020 were enrolled,of which the non-USCOM group had 34 cases from January 2017 to December 2018,mainly based on clinical indicators such as heart rate,blood pressure,blood lactate acid to evaluate the hemodynamic status of children after surgery.The USCOM group had 41 cases from January 2019 to December 2020,used USCOM to assist in the evaluation of hemodynamics of children after surgery dynamic state.Another 40 cases were set up as the control group,included neonates with hyperbilirubinemia.The USCOM group and the control group were examined by USCOM to record cardiac output(CO),cardiac index(CI),and systemic vascular resistance(SVR).The changes in CO,CI,SVR between the USCOM group and the control group,the changes in USCOM group before and after the operation were compared,respectively.Changes in heart rate,blood pressure,and lactic acid in the USCOM group before and after the operation were compared.And the differences of vasoactive drug dosage and time of first use after operation,postoperative first expansion time,volume expansion,incidence of anuria or oliguria within 24 hours after operation,and length of hospital stay between USCOM group and non-USCOM group were analyzed.Results The CO,CI,SVR,heart rate,blood pressure before operation in USCOM group were not significantly different compared with those in the control group and 12 h after the operation.The CO and CI in USCOM group at 1 h after operation were lower than those before operation,and the lactic acid increased,the differences were statistically significant(P<0.05).The SVR of USCOM group at 1 h after operation was higher than that before operation,but there was no significant difference(P>0.05).The CO and CI at 12 h after operation in USCOM group were higher than those at 1 h after operation,and the SVR at 12 h was lower than that at 1 h after operation,the differences were all statistically significant(P<0.05).There were no significant differences in heart rate and blood pressure in USCOM group before and 1 h after operation(P>0.05).The blood pressure at 12 h after operation was significantly higher than that at 1 h after operation(P<0.05).The time of first volume expansion and use of vasoactive drugs in USCOM group were significantly earlier than those in non-USCOM group[0.75(0.50,1.37)h vs.7.00(5.00,13.25)h,Z=-7.041,P<0.001;(1.39±1.33)h vs.(8.61±5.15)h,t=-7.917,P<0.001],the total volume of expansion was significantly reduced[17.50(10.00,30.00)mL vs.30.00(20.00,30.00)mL,t=-3.045,P=0.002],the dosage of dopamine was significantly reduced[8.40(6.20,10.40)mg/kg vs.8.90(7.20,14.40)mg/kg,Z=-2.475,P=0.013],the incidence of oliguria or anuria within 24 hours after operation was significantly reduced(12.2%vs.32.3%,t=4.500,P=0.034),the length of hospital stay was significantly shortened[25.00(15.50,31.00)d vs.28.00(21.75,34.00)d,Z=-1.985,P=0.047],and the dosage of dobutamine and epinephrine was not significantly changed(P>0.05).Conclusion Non-invasive hemodynamic monitoring can monitor the hemodynamic changes of the neonatal gastrointestinal tract in real time during the perioperative period,which is helpful to guide the management of vasoactive drugs and fluids after surgery.
作者
陈志泳
朱炜
黄英
庄德义
Chen Zhiyong;Zhu Wei;Huang Ying;Zhuang Deyi(Department of Neonatology,Xiamen Children's Hospital,Xiamen 361006,China)
出处
《中国小儿急救医学》
CAS
2022年第2期114-118,共5页
Chinese Pediatric Emergency Medicine
关键词
动态监测
无创血流动力学监测
围手术期管理
新生儿
Dynamic monitoring
Non-invasive hemodynamic monitoring
Perioperative management
Newborn
