摘要
目的评估小婴儿室间隔缺损(ventricular septal defect,VSD)修补术后左心室肌力指数(Smith-Madigan inotropy index,SMII)和外周血管阻力指数(systemic vascular resistance index,SVRI)的变化特点,为出院后患儿的随访治疗提供依据。方法选取2011年10月至2013年7月在广东省人民医院儿童重症监护室(PICU)和新生儿重症监护室(NICU)住院已成功接受VSD修补术的VSD小婴儿36例。所有研究对象在术后7~10 d、术后3个月、术后6个月分别使用超声心排血量监测仪(ultrasonic cardiac output monitor,USCOM)行血流动力学检查。采用SPSS软件方差分析和Bonferroni法分析术后左心室SMII和SVRI的变化特点。结果VSD修补术后小婴儿36例,男24例,女12例;月龄3(1~5)个月,体质量(4.32±0.87)kg。术后3个月随访率为89%(32/36),术后6个月随访率为81%(29/36)。VSD婴儿的左心室SMII在术后3个月较术后7~10 d明显下降,差异有统计学意义[(1.2±0.2)W·m^(2)vs.(1.4±0.5)W·m^(2),P<0.05];术后6个月与术后3个月比较,差异无统计学意义[(1.1±0.2)W·m^(2)vs.(1.2±0.2)W·m^(2),P>0.05]。SVRI在术后3个月较术后7~10 d有下降趋势,但差异无统计学意义[(973±1431)ds·cm^(-5)·m^(2)vs.(1055±268)ds·cm^(-5)·m^(2),P=0.072];术后6个月较术后3个月升高,差异有统计学意义[(1101±122)ds·cm^(-5)·m^(2)vs.(973±1431)ds·cm^(-5)·m^(2),P<0.01]。结论小婴儿VSD修补术后3个月内,左心室SMII、SVRI分别从术后早期的偏高水平,呈现不同程度的下降过程;继续随访至术后6个月,左心室SMII维持不变,SVRI出现生理性升高。使用USCOM实时快速随访VSD修补术后小婴儿的心血管功能,为术后用药提供准确个体化指导,对提高临床预后意义重大。
Objectives To evaluate the changes of left ventricular Smith-Madigan inotropy index(SMII)and systemic vascular resistance index(SVRI)after surgical repair of ventricular septal defect(VSD)in infants,in order to guide post-operative follow-up after discharge.Methods 7-10 days after VSD repair were enrolled. SMII,SVRI and other parameters were measured at 7-10 day,and at 3 and6 months after operation using ultrasonic cardiac output monitor(USCOM). Hemodynamic parameters were assessed and compared during the 6-month follow-up. Analysis of variance and Bonferroni method of SPSS were performed.Results Thirty-six subjects[38 male and 17 female,aging 3(1-5)months and weighing(4.32 ± 0.87)kg]were enrolled. Followup rate at 3 months was 89%(32/36),and 81%(29/36)at 6 months. During follow-up,left ventricular SMII decreased at 3 months postoperatively[(1.2±0.2)W·m^(2)vs.(1.4±0.5)W·m^(2),P<0.05]and then tended to be stable at 6 months[(1.1±0.2)W·m^(2)vs.(1.2±0.2)W·m^(2),P>0.05]. SVRI tended to decline at 3 months[(973±1431)ds·cm^(-5)·m^(2)vs.(1 055±268)ds·cm^(-5)·m^(2),P=0.072],but increased at 6 months[(1 101±122)ds·cm^(-5)·m^(2)vs.(973±1431)ds·cm^(-5)·m^(2),P<0.01].Conclusions In VSD infants after surgical repair,SMII and SVRI show a decline from a relatively high level to normal about 3 months postoperatively,then SMII keeps stable and SVRI increases as a physiological change at 6months postoperatively. USCOM may be a promising way to monitor the cardiovascular function in VSD infants after surgery,guiding individualized and rationalized medication during follow-up.
作者
陈晓博
何少茹
郑曼利
孙新
刘玉梅
孙云霞
陈寄梅
庄建
CHEN Xiao-bo;HE Shao-ru;ZHENG Man-li;SUN Xin;LIU Yu-mei;SUN Yun-xia;CHEN Ji-mei;ZHUANG Jian(Department of Neonatology,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of Pediatric Cardiac Surgery,Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)
出处
《岭南心血管病杂志》
CAS
2022年第2期110-115,共6页
South China Journal of Cardiovascular Diseases
基金
国家重点研发计划(项目编号:2018YFC1002603)
广东省医学科学基金(项目编号:2014A020212227)。
关键词
室间隔缺损
外科修补术
左心室肌力指数
外周血管阻力指数
血流动力学
小婴儿
ventricular septal defect
surgical repair
left ventricular Smith-Madigan inotropy index
systemic vascular resistance index
hemodynamics
infants
