CAJ | 학술논문

目的寻求简便、快捷、准确的方法监测新生儿的心输出量,提高NICU中危重症患儿的血流动力学诊治水平.方法同时采用超声心输出量监测仪(Uhyasonic cardiac output monitor uscom,USCOM)和多普勒超声心动图(Echocardiography,ECHO)测量20例健康足月儿及29例早产儿生后28 d内的心输出量,对测量结果使用Bland-Altman分析法比较两种方法的一致性.结果 Echo与Uscom测量足月儿组左心输出量时,两者的差值平均值和一致性区间为(30.6 ±51.1)ml/(kg·min),平均百分误差为21％.测量右心输出量时,两者的差值平均值和一致性区间为(-21.8±105)ml/(kg·min),平均百分误差为33.2％.两方法测量早产儿组左心输出量时,两者的差值平均值和一致性区间为(24.1±71.2)ml/(kg·min),平均百分误差为27.4％.测量右心输出量时,两者的差值平均值和一致性区间为(-29.5±192.9)ml/(kg·min),平均百分误差为51.8％.结论 USCOM与ECHO测量新生儿左心输出量时,无论足月儿还是早产儿一致性均较好,且操作简便、快捷、无创.测量右心输出量两种方法一致性欠佳,在早产儿中尤甚.USCOM方法虽有一定误差,但临床上动态测定判断趋势,有一定意义,研究其与常规多普勒超声比较有临床参考价值.
목적 심구간편、쾌첩、준학적방법감측신생인적심수출량,제고NICU중위중증환인적혈류동역학진치수평.방법 동시채용초성심수출량감측의(Uhyasonic cardiac output monitor uscom,USCOM)화다보륵초성심동도(Echocardiography,ECHO)측량20례건강족월인급29례조산인생후28 d내적심수출량,대측량결과사용Bland-Altman분석법비교량충방법적일치성.결과 Echo여Uscom측량족월인조좌심수출량시,량자적차치평균치화일치성구간위(30.6 ±51.1)ml/(kg·min),평균백분오차위21％.측량우심수출량시,량자적차치평균치화일치성구간위(-21.8±105)ml/(kg·min),평균백분오차위33.2％.량방법측량조산인조좌심수출량시,량자적차치평균치화일치성구간위(24.1±71.2)ml/(kg·min),평균백분오차위27.4％.측량우심수출량시,량자적차치평균치화일치성구간위(-29.5±192.9)ml/(kg·min),평균백분오차위51.8％.결론 USCOM여ECHO측량신생인좌심수출량시,무론족월인환시조산인일치성균교호,차조작간편、쾌첩、무창.측량우심수출량량충방법일치성흠가,재조산인중우심.USCOM방법수유일정오차,단림상상동태측정판단추세,유일정의의,연구기여상규다보륵초성비교유림상삼고개치.
Objective To assess agreement between the ultrasonic cardiac output monitor (USCOM) and conventional echocardiography (ECHO) in the measurement of cardiac output in newborn infants,investigate the accuracy and clinical utility of the USCOM in healthy neonates.To explore a more convenient,faster,more accurate hemodynamic monitoring method,for improving the outcome of the critically ill neonates.Method From October 1st,2011 to March 31st,2012,a total of 49 infants were included,20 were term infants,29 were preterm infants.Cardiac outputs were measured by both ultrasonic cardiac output monitor and echocardiography in all the infants,60 times measurements were done in both the term infants the preterm infants.The cardiac output of the left and right ventricles,heart rate,diameter and velocity time integral of the aortic valve and pulmonary artery valve of each infant were recorded.The consistency of two methods was analyzed as described by Bland-Altman.Result Term the term infant group includea 20 term infants,11 were male and 9 were female,the mean gestational age were (38.1 ± 0.56)weeks,mean age were (2 ± 1) days,mean weight were (3.2 ± 0.29) kg,mean Apgar score were 10.The mean left ventricular output measured by Echo was (242.3 ± 38.9) ml/(kg · min),measured by USCOM was (211.7 ±38.5) ml/(kg · min) ; The mean right ventricular output measured by ECHO was (318.9 ±47.0) ml/(kg · min),measured by USCOM was (340.7 ± 76) ml/(kg · min).Agreement between Echo and USCOM for left ventricular output (LVO) was (bias,± limits of agreement,mean ％ error):(30.6 ±51.1) ml/(kg · min),21％,and for right ventricular output (RVO):(-21.8 ± 105) ml/(kg · min),33.2％.The diameter of the aortic valve and pulmonary artery valve measured by conventional echocardiography were significantly larger than that estimated by ultrasonic cardiac output monitor (P ＜0.001).The velocity time integral of the pulmonary artery valve measured by ultrasonic cardiac output monitor were significantly larger than measured by conventional echocardiography (P ＜ 0.001).The heart rate,velocity time integral of the aortic valve measured by two methods had no significant differences(P ＞0.05).The preterm neonates group included 29 preterm infants,18 were male and 11 were female,the mean gestational age were (32.6 ± 2.8) weeks,mean age were (2 ± 1) days,mean weight were (1.88 ± 0.57) kg.All the infants were diagnosis as preterm infant,low birth weight.The mean left ventricular output measured by ECHO was (259.8 ±70)ml/(kg · min),measured by USCOM was (235.6± 61.8)ml/(kg · min),the mean right ventricular output measured by ECHO was (318.9-47.0)ml/(kg · min),measured by USCOM was (340.7± 76) ml/(kg · min).Agreement between Echo and USCOM for left ventricular output (LVO) was (bias,±limits of agreement,mean ％ error):(24.l ±71.2) ml/(kg · min),27.4％,and for right ventricular output (RVO):(-29.5 ± 192.9) mL/(kg · min),51.8％.The diameter of the aortic valve and pulmonary artery valve measured by conventional echocardiography were significantly larger than estimated by ultrasonic cardiac output monitor(P ＜ 0.001).The velocity time integral of the pulmonary artery valve measured by USCOM were significantly larger than that measured by conventional echocardiography(P ＜0.001).The heart rate,velocity time integral of the aortic valve measured by two methods had no significant differences (P ＞ 0.05).Conclusion Agreement between USCOM and conventional ECHO in the LVO measurement is acceptable,both in the term group and the preterm group.LVO measurement measured by USCOM is recommended.The accuracy and clinical utility of the USCOM in neonates is acceptable.USCOM is a convenient,fast and accurate hemodynamic monitoring method in neonates.While the agreement between USCOM and conventional ECHO in the RVO measurement is poor,especially in the preterm group,the results of the RVO cannot be considered interchangeable in the two methods.