Xiong Xiaoyu, Xu Feng, Qiu Wei, Li Shaojun, Liu Chengjun
Department of Pediatric Intensive Care Unit Children's Hospital of Chongqing Medical University Chongqing China.
National Clinical Research Center for Child Health and Disorders Chongqing China.
Pediatr Discov. 2024 Sep 12;3(2):e2505. doi: 10.1002/pdi3.2505. eCollection 2025 Jun.
This study aims to compare the efficiencies of three noninvasive technologies in monitoring the perioperative hemodynamics of children with congenital heart disease (CHD) including ventricular septal defects with or without atrial septal defects. Three noninvasive technologies included transthoracic echocardiography (TTE), electrical cardiometry (EC), and vasoactive inotropic score (VIS). Parameters included left ventricular ejection fraction (LVEF) and cardiac index (cardiac index monitored by ultrasound, uCI) in TTE, cardiac index (cardiac index monitored by electrical cardiometry, eCI) and systemic vascular resistance index (SVRI) in EC, and VIS. Seventy-four children were eligible. Three types of adverse events (AEs) related to disease activity and prognosis were observed, including cardio-pulmonary resuscitation in five cases (5/74, 6.76%), hypoxic-ischemic brain damage in four cases (4/74, 5.41%) and hemopurification in four cases (4/74, 5.41%). Except for LVEF, eight parameters (VISmax [maximum VIS], VISmea [mean VIS], uCImea [mean uCI], uCImin [minimum uCI], eCImea [mean eCI], eCImin [minimum eCI], SVRImea [mean SVRI], and SVRImin [minimum SVRI]) showed predictive value for any AE ( < 0.05). VISmea, uCImea, and eCImea demonstrated the highest accuracy and linear associations (AUROC > 0.9, = 0.00). Linear associations also existed between the three groups of parameters and the duration of mechanical ventilation (MV) and the length of stay (LOS) in the intensive care unit (ICU). The duration of MV and the LOS in the ICU increased as VISmea rose, or uCImea and eCImea fell ( < 0.05). LVEF in TTE could not predict any AE ( > 0.05) and not fully reflect the cardiovascular function. Therefore, most parameters obtained in TTE, EC, and VIS can reflect the perioperative hemodynamics of children with CHD, with VISmea, uCImea, and eCImea being most accurate.
本研究旨在比较三种非侵入性技术在监测先天性心脏病（CHD）患儿围手术期血流动力学方面的效率，这些患儿包括伴有或不伴有房间隔缺损的室间隔缺损患儿。三种非侵入性技术包括经胸超声心动图（TTE）、心电描记法（EC）和血管活性肌力评分（VIS）。参数包括TTE中的左心室射血分数（LVEF）和心脏指数（通过超声监测的心脏指数，uCI）、EC中的心脏指数（通过心电描记法监测的心脏指数，eCI）和全身血管阻力指数（SVRI）以及VIS。74名儿童符合条件。观察到三种与疾病活动和预后相关的不良事件（AE），包括5例心肺复苏（5/74，6.76%）、4例缺氧缺血性脑损伤（4/74，5.41%）和4例血液净化（4/74，5.41%）。除LVEF外，八个参数（VISmax[最大VIS]、VISmea[平均VIS]、uCImea[平均uCI]、uCImin[最小uCI]、eCImea[平均eCI]、eCImin[最小eCI]、SVRImea[平均SVRI]和SVRImin[最小SVRI]）对任何AE均显示出预测价值（<0.05）。VISmea、uCImea和eCImea显示出最高的准确性和线性相关性（AUROC>0.9，=0.00）。三组参数与机械通气（MV）持续时间和重症监护病房（ICU）住院时间（LOS）之间也存在线性相关性。随着VISmea升高，或uCImea和eCImea降低，MV持续时间和ICU住院时间增加（<0.05）。TTE中的LVEF无法预测任何AE（>0.05），也不能完全反映心血管功能。因此，TTE、EC和VIS中获得的大多数参数可以反映CHD患儿围手术期的血流动力学，其中VISmea、uCImea和eCImea最为准确。
