中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2015年
2期
105-109
,共5页
董慧茹%何少茹%庄建%郑曼利%潘微%张旭%陈晓博%钟劲%刘玉梅
董慧茹%何少茹%莊建%鄭曼利%潘微%張旭%陳曉博%鐘勁%劉玉梅
동혜여%하소여%장건%정만리%반미%장욱%진효박%종경%류옥매
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
心排齣量%機械通氣%早期早產兒%超聲心排齣量鑑測儀%多普勒超聲心動圖
심배출량%궤계통기%조기조산인%초성심배출량감측의%다보륵초성심동도
Cardiac output%Mechanical ventilation%Early preterm infant%Ultrasonic cardiac output monitor%Echocardiography
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-Altman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(361 ±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±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.
目的 探討超聲心排齣量鑑測儀(USCOM)測量危重癥早期早產兒心排齣量(CO)的準確性及其影響因素.方法 採用前瞻性研究,使用USCOM和多普勒超聲心動圖(ECHO)測量35例危重癥早期早產兒機械通氣時和無需任何呼吸支持下的CO,採用Bland-Altman法比較2種方法的一緻性.結果 機械通氣時USCOM和ECHO測得的左心排齣量(LVO)結果分彆為(361 ±62) mL/min和(376±93) mL/min,二者差值平均值和一緻性區間為(-0.2 ±205.7)mL/min,平均百分誤差為54.7％;右心排齣量(RVO)分彆為(608±152)mL/min和(453±106) mL/min,二者差值平均值和一緻性區間為(174.3±312.0) mL/min,平均百分誤差為112.0％.無需呼吸支持時USCOM和ECHO測得的LVO分彆為(394±95) mL/min和(374±55) mL/min,二者差值平均值和一緻性區間為(-20.2±119.5)mL/min,平均百分誤差為26.5％;RVO分彆為(585±103)mL/min和(453±106) mL/min,二者差值平均值和一緻性區間為(104.0±219.8) mL/min,平均百分誤差為67.2％.結論 USCOM測量機械通氣下危重癥早期早產兒LVO、RVO時與ECHO一緻性較差,這可能與內源性呼氣末正壓、平均呼吸道壓和早期過渡循環等因素有關,因此,早期需要機械通氣的危重癥早產兒心功能的評估仍需進一步研究;但不需要輔助呼吸時,2種方法測量CO均可靠.
목적 탐토초성심배출량감측의(USCOM)측량위중증조기조산인심배출량(CO)적준학성급기영향인소.방법 채용전첨성연구,사용USCOM화다보륵초성심동도(ECHO)측량35례위중증조기조산인궤계통기시화무수임하호흡지지하적CO,채용Bland-Altman법비교2충방법적일치성.결과 궤계통기시USCOM화ECHO측득적좌심배출량(LVO)결과분별위(361 ±62) mL/min화(376±93) mL/min,이자차치평균치화일치성구간위(-0.2 ±205.7)mL/min,평균백분오차위54.7％;우심배출량(RVO)분별위(608±152)mL/min화(453±106) mL/min,이자차치평균치화일치성구간위(174.3±312.0) mL/min,평균백분오차위112.0％.무수호흡지지시USCOM화ECHO측득적LVO분별위(394±95) mL/min화(374±55) mL/min,이자차치평균치화일치성구간위(-20.2±119.5)mL/min,평균백분오차위26.5％;RVO분별위(585±103)mL/min화(453±106) mL/min,이자차치평균치화일치성구간위(104.0±219.8) mL/min,평균백분오차위67.2％.결론 USCOM측량궤계통기하위중증조기조산인LVO、RVO시여ECHO일치성교차,저가능여내원성호기말정압、평균호흡도압화조기과도순배등인소유관,인차,조기수요궤계통기적위중증조산인심공능적평고잉수진일보연구;단불수요보조호흡시,2충방법측량CO균가고.
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.Comparison 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 percentage error was 67.2％.Conclusions 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 mechanical ventilation needs further study.But USCOM used in these infants without any respiratory support is reliable.
