应用USCOM动态监测新生儿外周动静脉同步换血左心功能的研究  

Application of USCOM to Dynamically Monitor the Left Ventricular Function of Neonates with Synchronized Peripheral Arteriovenous Transfusion

作　　者：杨伊琳[1] 蔡琍璇[2] 林开颜[2] YANG Yilin;CAI Lixuan;LIN Kaiyan(Department of Pediatrics,Shantou Central Hospital,Shantou,Guangdong Province,515031 China;Neonatal Intensive Care Unit,Department of Neonatology,Shantou Central Hospital,Shantou,Guangdong Province,515031 China)

机构地区：[1]汕头市中心医院儿科,广东汕头515031 [2]汕头市中心医院新生儿科新生儿重症监护病房,广东汕头515031

出　　处：《中外医疗》2021年第21期25-28,45,共5页China & Foreign Medical Treatment

基　　金：广东省医学科学技术研究基金项目(B2018216)。

摘　　要：目的探讨应用无创心排量监测系统(USCOM)动态监测新生儿外周动静脉同步换血左心功能的临床意义。方法方便选取该院2017年10月—2019年1月收治的因“新生儿高胆红素血症”需行外周动静脉同步换血的新生儿共20例,随机化入组“USCOM监测组(研究组)”及“无USCOM监测组(对照组)”,每组10例,应用USCOM动态监测研究组新生儿换血前、中、后左心功能,记录并分析研究组USCOM左心功能相关参数,比较两组换血速度、时长及效果等相关情况。结果研究组“换血中”“换血后”速度峰值(Vpk)[(“换血中”“换血后”0.92(0.73,0.95)、0.81(0.69,0.89)m/s vs“换血前”1.01(0.97,1.30)m/s]差异有统计学意义(Z=10.958,P<0.05)、每搏输出量指数(SVI)[17.00(14.00,18.33)、16.00(14.10,19.00)mL/m^(2) vs 19.00(19.00,25.00)mL/m^(2)]差异有统计学意义(Z=8.314,P<0.05)、心输出量(CO)[(0.49±0.09)、(0.41±0.10)L/min vs(0.65±0.18)L/min]差异有统计学意义(F=5.743,P<0.05)、心脏指数(CI)[(2.56±0.44)、(2.10±0.42)L/(min·m^(2))vs(3.32±0.88)L/(min·m^(2))],差异有统计学意义(F=6.345,P<0.05),“换血后”肌力指数(INO)[0.48(0.41,0.54)W/m^(2) vs 0.67(0.64,1.03)W/m^(2)]、单位体重心输出量(CO/kg)[(0.15±0.03)L/(min·kg)vs(0.24±0.07)L/(min·kg)]均较“换血前”明显下降,差异有统计学意义(P<0.05);“换血后”外周血管阻力指数(SVRI)较“换血前”明显上升,差异有统计学意义(P<0.05);“换血中”“换血后”势动能比(PKR)均较“换血前”明显上升[37.67(34.00,68.00)、48.00(40.25,83.50)vs 29.00(20.67,36.00)],差异有统计学意义(P<0.05);“换血中”“换血后”USCOM参数差异无统计学意义(P>0.05);研究组平均换血速度明显低于对照组[(45.59±5.95)mL/(kg·h)vs(56.94±6.12)mL/(kg·h)]、换血时长较对照组长[3.50(3.13,4.00)h vs 3.09(3.00,3.34)h],差异有统计学意义(P<0.05);两组换血效果差异无统计学意义(P>0.05)。结论新生儿外周动静脉同步�Objective To explore the clinical significance of using the non-invasive cardiac output monitoring system(USCOM)to dynamically monitor the left ventricular function of neonates with synchronized peripheral arteriovenous transfusion.Methods A total of 20 neonates who were admitted to the hospital from October 2017 to January 2019 who required simultaneous peripheral arteriovenous transfusion due to"neonatal hyperbilirubinemia"were convenient selected and randomized into"the USCOM monitoring group(study group)”and“no USCOM monitoring group(control group)”,10 cases in each group,used USCOM to dynamically monitor the left ventricular function of the neonates in the study group before,during and after exchange transfusion,and recorded and analyzed the relevant parameters of the USCOM left ventricular function in the study group.Compared the speed,duration and effect of exchange blood between the two groups.Results There was a statistically significant in the peak velocity(Vpk)of the study group"during exchange"and"after exchange"("during exchange","after exchange"0.92(0.73,0.95)m/s,0.81(0.69,0.89)m/s vs"before exchange"1.01(0.97,1.30)m/s](Z=10.958,P<0.05),there was a statistically significant in the stroke volume index(SVI)[17.00(14.00,18.33),16.00(14.10,19.00)mL/m^(2) vs 19.00(19.00,25.00)mL/m^(2),(Z=8.314,P<0.05),there was a statistically significant in the cardiac output(CO)[(0.49±0.09)L/min,(0.41±0.10)L/min vs(0.65±0.18)L/min](F=5.743,P<0.05),there was a statistically significant in the cardiac index(CI)[(2.56±0.44)L/(min·m^(2)),(2.10±0.42)L/(min·m^(2))vs(3.32±0.88)L/(min·m^(2))](F=6.345,P<0.05),the muscle strength index(INO)[0.48(0.41,0.54)W/m^(2) vs 0.67(0.64,1.03)W/m^(2)],The output per unit of gravity(CO/kg)[(0.15±0.03)L/(min·kg)vs(0.24±0.07)L/(min·kg)]was significantly lower than"before exchange",the difference was statistically significant(P<0.05);Peripheral vascular resistance index(SVRI)increased significantly after“exchange”compared with“before exchange”,and the difference was s

关 键 词：动态监测 USCOM 左心输出量 新生儿 外周动静脉同步换血 

分 类 号：R722.1[医药卫生—儿科]