河北医科大学学报 ›› 2023, Vol. 44 ›› Issue (1): 81-85,90.doi: 10.3969/j.issn.1007-3205.2023.01.016

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无创心输出量监测在暴发性心肌炎患儿中的应用

  

  1. 1.河北医科大学附属河北省儿童医院重症监护科，河北 石家庄 050031；2.河北医科大学附属河北省儿童医院感染科，河北 石家庄 050031

  • 出版日期:2023-01-25 发布日期:2023-01-17
  • 作者简介:康磊（1986-），男，满族，河北唐山人，河北医科大学附属河北省儿童医院主治医师，医学硕士，从事儿童重症感染疾病诊治研究。
  • 基金资助:
    河北省医学科学研究课题计划(20190796)

Application value of non-invasive hemodynamic monitoring in children with fulminant myocarditis

  1. 1.Department of Pediatric Intensive Care Unit, Hebei Children′s Hospital/the Affiliated of Hebei Medical 
    University, Shijiazhuang 050031，China； 2.Department of Infectious Disease, Hebei Children′s 
    Hospital/the Affiliated of Hebei Medical University, Shijiazhuang 050031，China

  • Online:2023-01-25 Published:2023-01-17

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摘要： 目的  探讨无创心输出量监测系统(non-invasive cardiac system，NICaS)在暴发性心肌炎(fulminant myocarditis，FM)患儿中的应用价值。
方法  纳入FM患儿39例作为试验组，同期住院的肺炎患儿47例作为对照组。2组均行NICaS和经胸超声心动图(transthoracic echocardiography，TTE)检查，监测心脏指数(cardiac index,CI)、△CI、格兰夫-高尔指数(Granov Goor index,GGI)及左心室射血分数(left ventricular ejection fraction,LVEF)等参数，比较试验组患儿NICaS和TTE参数的差异及相关性；试验组随机分为A1组(n=21，参照NICaS制定治疗方案）和A2组（n=18，参照TTE制定治疗方案），比较2组预后。 
结果  试验组TTE和NICaS测得的CI均小于对照组，试验组NICaS测得的CI小于TTE，差异有统计学意义(P＜0.05)。Pearson相关性分析显示，试验组和对照组NICaS与TTE测得的CI呈显著正相关（r=0.853，0.751，P＜0.001)。Bland-Altman分析显示，NICaS与TTE测量△CI的一致性良好(P=0.079)；NICaS测得的GGI与TTE测得的LVEF呈显著正相关（r=0.727，P＜0.001）。A1组输液量少于A2组，达到液体负平衡所需时间短于A2组，病死率小于A2组，差异有统计学意义(P＜0.05)。
结论  NICaS对FM患儿CI与TTE一致性良好。NICaS可为FM患儿提供简单、无创、连续和可靠的血流动力学测量，进而改善预后。


关键词: 心肌炎, 无创心输出量监测系统, 心脏指数

Abstract: Objective  To investigate the application value of non-invasive cardiac system (NICaS) in children with fulminant myocarditis (FM). 
Methods  A total of 39 children with FM were included as the experimental group, and 47 children with pneumonia hospitalized during the same period as the control group. The cardiac index (CI), △CI, Granov Goor index (GGI) and left ventricular ejection fraction (LVEF) of both groups were monitored by NICaS and transthoracic echocardiography (TTE), and the difference in NICaS and TTE and their correlation in experimental group were compared. The experimental group was randomly divided into group A1 (n=21), in which treatment protocols were formulated by NICaS and group A2 (n=18) in which treatment protocols were formulated by TTE. The prognosis of the two groups was compared. 
Results  The CI measured by TTE and NICaS in the experimental group was smaller than that in the control group, and the CI measured by NICaS was smaller than that by TTE in the experimental group, suggesting significant difference (P＜0.05). Pearson correlation analysis showed a significantly positive correlation between the CI measured by NICaS and that by TTE in the experimental group and the control group (r=0.853, 0.751, P＜0.001). Bland-Altman analysis showed good consistency (P=0.079) between the △CI measured by TTE and NICaS (P=0.079), and GGI measured by NICaS was significantly correlated with LVEF by TTE (r=0.727, P＜0.001). Group A1 required less infusion volume, shorter time to achieve negative fluid balance, and had a smaller mortality than group A2, all of which were statistically significant. 
Conclusion  NICaS has good consistency with TTE in terms of CI in children with FM, which can provide simple, non-invasive, reliable and continuous hemodynamic measurements for children with FM, thereby improving the prognosis. 

Key words: myocarditis, non-invasive hemodynamic monitoring, cardiac index

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