儿童先天性心脏病围术期监测与血管活性药物应用现状的多中心调查  

A multi-center survey of current postoperative application of vasoactive agents in children undergoing congenital heart surgery with cardiopulmonary bypass

作　　者：龚霄雷 朱丽敏[1] 刘玉洁[1] 张明杰 徐卓明[1] Gong Xiaolei;Zhu Limin;Liu Yujie;Zhang Mingjie;Xu Zhuoming(Department of Cardiovascular Thoracic Surgery,Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科

出　　处：《中国体外循环杂志》2019年第3期132-136,152,共6页Chinese Journal of Extracorporeal Circulation

摘　　要：目的通过调查研究,了解国内儿童先天性心脏病中心在先天性心脏病体外循环术后监测、围术期血管活性药物使用现状和特点,为今后进一步研究奠定基础。方法通过参阅近年文献和结合国外的问卷调查结果,发起了本次调查问卷。主要包括三部分内容:①围术期血流动力学监测项目;②手术中血管活性药物的使用;③体外循环手术后血管活性药物的使用。结果血流动力学基础监测覆盖率几乎能达到100%,77%的中心能做到心输出量监测,41%可进行微循环监测,与国外仍有较大差距。对于预防术后低心排血量综合征(LCOS),各中心以多巴胺为主要用药。在三种不同类型LCOS的治疗调查中,本结果与国外调查基本相符,即主要策略为:LCOS伴体循环阻力增高采用米力农,LCOS伴体循环阻力降低采用多巴胺、肾上腺素,而LCOS伴肺循环阻力增高以米力农+儿茶酚胺类药物+肺血管扩张剂为主。结论 目前国内儿童心脏中心均能进行基础血流动力学检测,但心输出量、微循环监测等仍与国外有一定差距;血管活性药物的使用策略与国外基本相同,但各中心之间用药差异仍较大。期待有更多高质量多中心随机对照血管活性药物的临床试验以及诊疗指南或专家共识,以指导临床医生正确使用血管活性药物。Objective The aim of this survey was to analyze the current status and features of postoperative hemodynamic monitoring and perioperative application of vasoactive agents in 17 pediatric heart centers in China, and to establish basics for further investigations. Methods A questionnaire survey was carried out, including perioperative hemodynamic monitoring, prophylactic use of vasoactive agents during surgery with cardiopulmonary bypass and postoperative application of vasoactive agents according to recently published articles and surveys. Results Basic hemodynamic monitoring was implemented in all 17 centers, but cardiac output and microcirculation were measured in only 77% and 41% of the centers respectively. Dopamine was preferred by most centers for the prevention of postoperative low cardiac output syndrome (LCOS). Patients suffered from LCOS with high systemic vascular resistance (SVR) were more likely to be treated was treated with milrinone whilst LCOS with low SVR was treated with dopamine and adrenaline. However, LCOS with high pulmonary vascular resistance with milrinone+catecholamines+pulmonary vasodilators, which was similar to the results from Western countries. Conclusion Basic hemodynamic monitoring is implemented well in Chinese pediatric heart centers, but the application of advanced hemodynamic monitoring is not compared with international centers. The strategy of vasoactive drug application is similar to international centers but differs among institutions. More randomized control trials and clinical guidelines are prospected to instruct intensivists to utilize vasoactive agents in future.

关 键 词：先天性心脏病 体外循环 心脏手术 监测 血管活性药物 调查 

分 类 号：R726.5[医药卫生—儿科]