小儿先天性心脏病术后血液动力学的临床研究

发布时间：2018-09-08 13:23

【摘要】：目的：应用连续多普勒超声心排血量监测仪（USCOM)对小儿先天性心脏病（先心病）术后进行血流动力学监测，了解先心术后患儿心功能变化。评估中心静脉血氧饱和度（ScvO_2)、动脉血乳酸（Lac)、心率（HR)、平均动脉压（MAP)等能否反映心功能变化。方法：前瞻性研究，选取重庆医科大学附属儿童医院2011年9月至11月期间在体外循环+全身麻醉下完成先天性心脏病心脏直视手术患儿资料26例。应用USCOM对术后24h(lh,4h,8h,24h)内心脏指数(CI)进行测定，同时记录各时间点Lac，ScvO_2，HR, MAP等值。按照术前心脏彩超测得肺动脉高压（PH)程度、体外循环时间（CPBT)、年龄、体重四种方式进行分组。统计方法：运用SPSS17.0软件进行处理，组间各时间点CI值进行对比研究，描绘CI变化趋势图，并将ScvO_2、Lac、HR、MAP等值与CI值作相关性分析。结果：所有患儿均顺利出院，，研究期间未发生与USCOM相关的并发症。总体来说术后患儿CI值在4h达到最高点，术后8h达到最低点，24hCI有所上升接近lhCI值。分组后CI结果：无-轻度PH组大于中-重度PH组，术后8h差异有统计学意义（p0.05); CPBT60min组大于CPBT彡60min组，术后8h、24h差异有统计学意义（p0.05);年龄彡12月组大于年龄12月组，术后8h差异有统计学意义(p0.05);体重》10kg组与体重10kg组在各时间点差异均无统计学意义(p0.05)o CI值在各时间点与ScvO_2有显著正相关性（lh: r=0.748,p0.05；4h： r=0.611, p0.05；8h： r=0.680, p0.05；24h： r=0.809,p0.05),与Lac、HR、MAP相关性无统计学意义（p0.05)。结论：USCOM作为一种无创心排血量监测手段，可以反映小儿先天性心脏病术后心功能的变化趋势。婴幼儿室间隔缺损（VSD)术后心功能在8h左右降至最低，尤其是伴有中-重度PH、CPBT彡60min、年龄12m的患儿更为明显。ScvO_2能实时的反映出心输出量对组织器官供氧状况，间接反应出术后心功能变化情况。Lac、HR、MAP等均不能反映术后心功能变化情况。
[Abstract]:Objective: to investigate the changes of cardiac function after congenital heart disease (CHD) in children with congenital heart disease (CHD) by continuous Doppler echocardiography (USCOM). To evaluate whether central venous oxygen saturation (ScvO_2), arterial lactate (Lac), heart rate, (HR), mean arterial pressure (MAP) can reflect cardiac function changes. Methods: a prospective study was conducted in 26 children with congenital heart disease undergoing open heart surgery under general anesthesia under cardiopulmonary bypass from September to November 2011 in the Children's Hospital affiliated to Chongqing Medical University. Cardiac index (CI) was measured 24 hours after operation (lh,4h,8h,24h) by USCOM, and Lac,ScvO_2,HR, MAP equivalent at each time point was recorded. According to the preoperative (PH) degree of pulmonary hypertension, (CPBT), age and body weight measured by color Doppler echocardiography, the patients were divided into four groups. Statistical methods: the SPSS17.0 software was used to process the data, and the CI values at different time points were compared and studied. The trend map of CI changes was depicted, and the correlation analysis between ScvO_2,Lac,HR,MAP equivalence and CI value was made. Results: all the children were discharged smoothly and no complications related to USCOM occurred during the study. In general, the CI value reached the highest point at 4 h after operation, and reached the lowest point at 8 h after operation. The CI increased to close to lhCI value at 8 h after operation. The results of CI showed that the difference of CI in non-mild PH group was greater than that in moderate to severe PH group (p0.05), in CPBT60min group was larger than CPBT 60min group (p0.05), there was significant difference at 8 h and 24 h after operation (p0.05), and the age of 12 months group was larger than that of age 12 months group (p0.05). There was no significant difference between weight > 10kg group and body weight 10kg group at every time point (p0.05) o CI value was significantly correlated with ScvO_2 at each time point (lh: r 0.748p 0.05 h: r 0.611, p 0.05n 8h: r 0.680, p 0.05). 24 h: rhombus 0.809 (p0.05), and no significant correlation with Lac,HR,MAP (p0.05). Conclusion as a non-invasive method of monitoring cardiac output, USCOM can reflect the trend of cardiac function in children with congenital heart disease after operation. The heart function of infants with ventricular septal defect (VSD) decreased to the lowest at about 8 hours after (VSD), especially in children with moderate to severe PH,CPBT for 60 mins. In children with 12 m age, it was more obvious that the cardiac output could reflect the state of oxygen supply to tissues and organs in real time. The changes of cardiac function after operation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R726.5

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