2种方法评估危重症早期早产儿心排出量的准确性  

Two methods used for evaluating cardiac output accuracy in early preterm infants with critical illness

作　　者：董慧茹[1] 何少茹[2] 庄建[2] 郑曼利[1] 潘微[2] 张旭[2] 陈晓博[1] 钟劲[1] 刘玉梅[1] 梁穗新[1] 孙云霞[1] 

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

出　　处：《中华实用儿科临床杂志》2015年第2期105-109,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家“十二五”科技支撑计划项目（2011BAIllB22）

摘　　要：目的探讨超声心排出量监测仪（USCOM）测量危重症早期早产儿心排出量（CO）的准确性及其影响因素。方法采用前瞻性研究，使用USCOM和多普勒超声心动图（ECHO）测量35例危重症早期早产儿机械通气时和无需任何呼吸支持下的CO，采用Bland—Airman法比较2种方法的一致性。结果机械通气时USCOM和ECHO测得的左心排出量（LVO）结果分别为（3614±62）mL/min和（376±93）mL/min，二者差值平均值和一致性区间为（-0．2±205．7）mL／min，平均百分误差为54．7％；右心排出量（RVO）分别为（608±152）mL/min和（453±106）mL／min，二者差值平均值和一致性区间为（174．3±312．0）mL/min，平均百分误差为112．0％。无需呼吸支持时USCOM和ECHO测得的LVO分别为（394±95）mL／min和（374±55）mL／min，二者差值平均值和一致性区间为（-20．2±119．5）mL／min，平均百分误差为26．5％；RVO分别为（585±103）mL/min和（453．4±106）mL/min，二者差值平均值和一致性区间为（104．0±219．8）mL/min，平均百分误差为67．2％。结论USCOM测量机械通气下危重症早期早产儿LVO、RVO时与ECHO一致性较差，这可能与内源性呼气末正压、平均呼吸道压和早期过渡循环等因素有关，因此，早期需要机械通气的危重症早产儿心功能的评估仍需进一步研究；但不需要辅助呼吸时，2种方法测量CO均可靠。Objective To assess the accuracy and factors of ultrasonic cardiac output monitor （USCOM） of cardiac output （CO） in critically ill early preterm infants. Methods A prospective study was conducted in 35 cases of early preterm infants who were critically ill by mechanical ventilation and without any respiratory support after birth. CO was measured by using USCOM and Echocardiography （ECHO）. Bland - Altman analysis was performed. Results When ventilated left ventricular output （LVO） measured by USCOM and ECHO was （361 ± 62） mL/min and （376 ± 93） mL/min, respectively; while the right ventricular output （RVO） was （ 608 ± 152 ） mL/min and （453 ± 106 ） mL/min,respectively. Comparison made by 2 techniques for LVO showed a bias -± limits of agreement of （ -0.2 ± 205.7） mL/min,the average percentage error was 54.7% ;for RVO,the bias ± limits of agreements was （ 174.3± 312. 0） mL/min ,and the average percentage error was 112.0%. Without any respiratory support, LVO were （394 ± 95 ） mL/min and （374 ±55） mL/min;while RVO were （585 ± 103） mL/min and （453 -± 106） mL/min,respectively. Com- parlson made by 2 techniques for LVO showed a bias ± limits of agreement of （ - 20.2 ± 119.5 ） mL/min, and the average percentage error was 26.5% ;for RVO, the bias ± limits of agreements was （104.0 ± 219.8 ）mL/min, and the average per- eentage error was 67.2%. Conchlsions The consistency of USCOM and ECHO in LVO and RVO is poor when used in preterm infants during mechanical ventilation ; which may be related to endogenous end - expiratory pressure, average airway pressure,transition and other factors, so cardiac function assessment in critically ill preterm infants during mecha- nical ventilation needs further study. But USCOM used in these infants without any respiratory support is reliable.

关 键 词：心排出量 机械通气 早期早产儿 超声心排出量监测仪 多普勒超声心动图 

分 类 号：R722.6[医药卫生—儿科]