Chen Jing, Li Jia, Wang Xingpeng, Ma Kai, Xu Jie, Zhang Huifang, Su Yufei, Li Hua
Department of Emergency, Xi'an Children's Hospital (The Affiliated Children's Hospital of Xi'an Jiaotong University), Shaanxi, 710003, PR China.
Department of Endocrinology and Metabolic Genetics, Xi'an Children's Hospital (The Affiliated Children's Hospital of Xi'an Jiaotong University), Shaanxi, 710003, PR China.
BMC Emerg Med. 2025 Jul 1;25(1):108. doi: 10.1186/s12873-025-01264-2.
This study aimed to evaluate cardiac preload and identify early predictors of severe trauma in pediatric patients using non-invasive hemodynamic monitoring in the pediatric emergency department.
A prospective cohort study was conducted at Xi'an Children's Hospital (June 2022-October 2024) with 167 patients, divided into mild (84) and severe (83) trauma groups. Non-invasive monitoring began shortly after admission, collecting parameters alongside clinical and laboratory assessments.
No significant differences in demographics or injury characteristics were found between groups. The severe trauma group had higher blood transfusion requirements (TAR) (p < 0.01). Hemodynamic parameters showed reduced pre-ejection period (PEP), left ventricular ejection time, and thoracic fluid content (t = 5.655, z = -4.368, z = -3.702; p < 0.01), indicating insufficient preload. Elevated heart rate (t = -4.127; p < 0.01) compensated for this. Reduced stroke volume index (t = 2.339, p < 0.05) and higher cardiac index (z = -1.979; p < 0.05) suggested compensation for low hemoglobin. The severe group also had elevated white blood cells, blood glucose, lactate, interleukin-6, interleukin-10, ALT, and AST (p < 0.01), while hemoglobin, fibrinogen, and albumin were decreased (p < 0.01). Logistic regression identified PEP, albumin, interleukin-6, and TAR as independent risk factors for severe trauma (p < 0.05). PEP and interleukin-6 had the highest area under the curve values (> 0.70).
Non-invasive hemodynamic monitoring can detect early signs of insufficient preload in severe pediatric trauma, and the combination of PEP and interleukin-6 aids in severity assessment and clinical decision-making.
Not applicable.
本研究旨在通过在儿科急诊科使用无创血流动力学监测来评估小儿患者的心脏前负荷，并确定严重创伤的早期预测指标。
在西安儿童医院（2022年6月至2024年10月）进行了一项前瞻性队列研究，纳入167例患者，分为轻度创伤组（84例）和重度创伤组（83例）。入院后不久即开始无创监测，同时收集参数以及进行临床和实验室评估。
两组在人口统计学或损伤特征方面未发现显著差异。重度创伤组的输血需求（TAR）更高（p < 0.01）。血流动力学参数显示射血前期（PEP）、左心室射血时间和胸腔液体含量降低（t = 5.655，z = -4.368，z = -3.702；p < 0.01），表明前负荷不足。心率升高（t = -4.127；p < 0.01）对此起到了代偿作用。每搏量指数降低（t = 2.339，p < 0.05）和心脏指数升高（z = -1.979；p < 0.05）提示对低血红蛋白的代偿。重度组的白细胞、血糖、乳酸、白细胞介素-6、白细胞介素-10、谷丙转氨酶和谷草转氨酶也升高（p < 0.01），而血红蛋白、纤维蛋白原和白蛋白降低（p < 0.01）。逻辑回归分析确定PEP、白蛋白、白细胞介素-6和TAR为严重创伤的独立危险因素（p < 0.05）。PEP和白细胞介素-6的曲线下面积值最高（> 0.70）。
无创血流动力学监测可检测出重度小儿创伤患者前负荷不足的早期迹象，PEP和白细胞介素-6的联合应用有助于严重程度评估和临床决策。
不适用。
