Choi Deok Young, Kwak Hyun Jeong, Park Hee Yeon, Kim Yong Beom, Choi Chang Hyu, Lee Ji Yeon
Division of Cardiology, Department of Pediatrics, Gachon University of Medicine and Science, Incheon, 405-760, Republic of Korea.
Pediatr Cardiol. 2010 Nov;31(8):1166-70. doi: 10.1007/s00246-010-9776-8. Epub 2010 Aug 13.
This study aimed to compare respiratory variation in transthoracic echo-derived aortic blood flow velocity (∆Vpeak) and inferior vena cava diameter (∆IVCD) with central venous pressure (CVP) as predictors of fluid responsiveness in children after repair of ventricular septal defect (VSD). A prospective study conducted in pediatric intensive care unit investigated 21 mechanically ventilated children who had undergone repair of VSD. Standardized volume replacement (VR) was the intervention used. Hemodynamic measurements including CVP, heart rate, mean arterial pressure, transthoracic echo-derived stroke volume (SV), cardiac output, ∆Vpeak, and ∆IVCD were performed 1 h after patient arrival in the intensive care unit. Hemodynamic measurements were repeated 10 min after VR by an infusion of 6% hydroxyethyl starch 130/0.4 (10 ml/kg) over 20 min. The volume-induced increase in the SV was 15% or more in 11 patients (responders) and less than 15% in 10 patients (nonresponders). Before volume replacement, the ∆Vpeak (23.1 ± 5.7% vs. 14.0 ± 7.7%; p = 0.006) and ∆IVCD (26.5 ± 16.2% vs. 9.2 ± 9.1%; p = 0.008) was higher in the responders than in the nonresponders, whereas CVP did not significantly differ between the two groups. The prediction of fluid responsiveness was higher with the ΔVpeak, as shown by a receiver operating characteristic curve area of 0.83 (95% confidence interval [CI], 0.61-1.00; p = 0.01), a ΔIVCD of 0.85 (95% CI, 0.69-1.00; p = 0.01), and a CVP of 0.48 (95% CI, 0.22-0.73; nonsignificant difference). The ∆Vpeak and ∆IVCD measured by transthoracic echocardiography can predict the response of SV after volume expansion in mechanically ventilated children at completion of VSD repair.
本研究旨在比较经胸超声心动图得出的主动脉血流速度呼吸变异（∆Vpeak）和下腔静脉直径呼吸变异（∆IVCD）与中心静脉压（CVP），以作为室间隔缺损（VSD）修补术后儿童液体反应性的预测指标。在儿科重症监护病房进行的一项前瞻性研究，纳入了21例接受VSD修补术的机械通气儿童。采用的干预措施是标准化容量补充（VR）。在患者入住重症监护病房1小时后，进行包括CVP、心率、平均动脉压、经胸超声心动图得出的每搏输出量（SV）、心输出量、∆Vpeak和∆IVCD在内的血流动力学测量。通过在20分钟内输注6%羟乙基淀粉130/0.4（10 ml/kg）进行VR，10分钟后重复血流动力学测量。11例患者（反应者）容量诱导的SV增加≥15%，10例患者（无反应者）<15%。容量补充前，反应者的∆Vpeak（23.1±5.7%对14.0±7.7%；p = 0.006）和∆IVCD（26.5±16.2%对9.2±9.1%；p = 0.008）高于无反应者，而两组间CVP无显著差异。如受试者工作特征曲线面积所示，∆Vpeak对液体反应性的预测性更高，为0.83（95%置信区间[CI]，0.61 - 1.00；p = 0.01），∆IVCD为0.85（95%CI，0.69 - 1.00；p = 0.01），CVP为0.48（95%CI，0.22 - 0.73；无显著差异）。经胸超声心动图测量的∆Vpeak和∆IVCD可预测VSD修补术完成后机械通气儿童容量扩张后SV的反应。
