超声心排出量监测仪测量小婴儿室间隔缺损修补术术后心排出量的准确性  

Clinical validaty of the ultrasonic cardiac output monitor used in infants after surgical repair of ventricular septal defect

作　　者：陈晓博[1,2] 何少茹[1,2] 庄建[1] 孙新[2] 钟劲[1] 王树水[1] 郑曼利[1] 刘玉梅[1] 孙云霞[1] 

机构地区：[1]广东省心血管病研究所儿童心脏中心,广州510080 [2]广东省医学科学院广东省人民医院新生儿科

出　　处：《中华实用儿科临床杂志》2013年第23期1776-1779,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：围家“十二五”科技支撑计划项目（2011BAI11B22）

摘　　要：目的评价超声心排出量监测仪（USCOM）测量小婴儿VSD修补术后心排出量（CO）的准确性和临床应用价值。方法采用前瞻性研究，选取2011年10月至2013年7月广东省人民医院NICU和PICU收治的VSD修补术后小婴儿，同时采用USCOM和多普勒超声心动图（ECHO）2种方法对照进行CO测定。测量结果采用配对t检验和Bland—Altman分析法比较其一致性。结果VSD修补术后小婴儿55例。男38例，女17例；月龄1～6个月；体质量2．42～6．50kg，共进行90例次USCOM和ECHO测量的对照。USCOM和ECHO测得的左心排出量（LVO）结果分别为（282．0-4-74．2）mIM（kg·min）和（287．0±61．1）mL／（kg·rain），二者差值平均值和一致性区间为（一5．6±85．8）mL／（kg·rain），平均百分误差为29．86％。USCOM与ECHO测得的右心排出量（RVO）结果分别为（371．0-＋-133．0）mL／（kg·min）和（377．0±107．0）mE／（kg·min），二者差值平均值和一致性区间为（-6．0±271．4）mE／（kg·min），平均百分误差为77．24％。结论USCOM与ECHO测量小婴儿VSD修补术后LVO时一致性较好，测量RVO时一致性较差。USCOM操作便捷，临床上将其用于小婴儿VSD修补术后左心功能监测，进而指导治疗有一定的应用前景；在用于右心功能监测时误差较大，需进一步研究。Objective To investigate the accuracy and clinical utility of ultrasonic cardiac output monitor （USCOM） to measure cardiac output（CO） of infants after receiving repair of ventricular sept defect（VSD）. Methods A prospective and observational study was conducted at Departments of NICU and PICU in Guangdong General Hos- pital with infant samples after receiving surgical repair of VSD 6：ore Oct. 20l 1 to Jul. 2013. Paired measures of cardiac output were obtained by using USCOM and ECHO. Paired t-test and Bland-Airman analysis were performed. Results Fifty-five subjects（ 38 male and 17 female ,aged 1 -6 months and weighing 2.42 -6.50 kg） were enrolled for the final analysis. And 90-time findings from comparing cardiac output measures were obtained. The left ventricular output （LVO） measured by USCOM and ECHO was （282.0 ＋74.2） mL/（ kg ~ min） and （287.0 -＋61.1 ） mL/（ kg ~ rain）, respectively;while the right ventricular output（RVO） was （371.0 -＋ 133.0） mL/（ kg ~ rain） and （377.0 -＋ 107. O） mL/（ kg ~ rain） ,respectively. Comparison by 2 techniques for LVO showed a bias -＋ limits of agreement of （ -5.6 -＋ 85.8 ） mL/（ kg ~ min） , a percentage error of 29.86% ; for RVO, the bias ＋ limits of agreement was （ - 6.0 ＋ 271.4） mL/（kg ~ rain） ,and the percentage error was 77.24%. Conclusions The consistency of USCOM and ECHO in LVO measurement is acceptable, while poor in RVO measurement. Due to its safe, feasible and noninvasive nature, the USCOM may play an important role in hemodynamic monitoring of the left ventricular function in infants after surgical repair of VSD. Whereas,USCOM may not be recommended for the assessment of right ventricular function.

关 键 词：心排出量 超声心排出量监测仪 多普勒超声心动图 室间隔缺损修补术 婴儿 

分 类 号：R726.5[医药卫生—儿科]