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Objective:To explore the value of ultrasonic cardiac output monitor(USCOM) in guiding perioperative hemodynamic management of neonatal gastrointestinal surgery.Methods:Seventy-five neonates with hemodynamic changes after gastrointestinal surgery admitted to the Department of Neonatology, Xiamen Children′s Hospital from January 2017 to December 2020 were enrolled, of which the non-USCOM group had 34 cases from January 2017 to December 2018, mainly based on clinical indicators such as heart rate, blood pressure, blood lactate acid to evaluate the hemodynamic status of children after surgery.The USCOM group had 41 cases from January 2019 to December 2020, used USCOM to assist in the evaluation of hemodynamics of children after surgery dynamic state.Another 40 cases were set up as the control group, included neonates with hyperbilirubinemia.The USCOM group and the control group were examined by USCOM to record cardiac output(CO), cardiac index(CI), and systemic vascular resistance(SVR). The changes in CO, CI, SVR between the USCOM group and the control group, the changes in USCOM group before and after the operation were compared, respectively.Changes in heart rate, blood pressure, and lactic acid in the USCOM group before and after the operation were compared.And the differences of vasoactive drug dosage and time of first use after operation, postoperative first expansion time, volume expansion, incidence of anuria or oliguria within 24 hours after operation, and length of hospital stay between USCOM group and non-USCOM group were analyzed.Results:The CO, CI, SVR, heart rate, blood pressure before operation in USCOM group were not significantly different compared with those in the control group and 12 h after the operation.The CO and CI in USCOM group at 1 h after operation were lower than those before operation, and the lactic acid increased, the differences were statistically significant( P<0.05). The SVR of USCOM group at 1 h after operation was higher than that before operation, but there was no significant difference ( P>0.05). The CO and CI at 12 h after operation in USCOM group were higher than those at 1 h after operation, and the SVR at 12 h was lower than that at 1 h after operation , the differences were all statistically significant( P<0.05). There were no significant differences in heart rate and blood pressure in USCOM group before and 1 h after operation ( P>0.05). The blood pressure at 12 h after operation was significantly higher than that at 1 h after operation( P<0.05). The time of first volume expansion and use of vasoactive drugs in USCOM group were significantly earlier than those in non-USCOM group[0.75(0.50, 1.37)h vs.7.00(5.00, 13.25)h, Z=-7.041, P<0.001; (1.39±1.33)h vs.(8.61±5.15)h, t=-7.917, P<0.001], the total volume of expansion was significantly reduced[17.50(10.00, 30.00)mL vs.30.00(20.00, 30.00)mL, t=-3.045, P=0.002], the dosage of dopamine was significantly reduced[8.40(6.20, 10.40)mg/kg vs.8.90(7.20, 14.40)mg/kg, Z=-2.475, P=0.013], the incidence of oliguria or anuria within 24 hours after operation was significantly reduced(12.2% vs.32.3%, t=4.500, P=0.034), the length of hospital stay was significantly shortened[25.00(15.50, 31.00)d vs.28.00(21.75, 34.00)d, Z=-1.985, P=0.047], and the dosage of dobutamine and epinephrine was not significantly changed( P>0.05). Conclusion:Non-invasive hemodynamic monitoring can monitor the hemodynamic changes of the neonatal gastrointestinal tract in real time during the perioperative period, which is helpful to guide the management of vasoactive drugs and fluids after surgery.
RESUMO
Exercise rehabilitation is an important method for the prevention and treatment of cardiovascular diseases(CVD). Non-invasive hemodynamic monitoring has the advantage of effectively recording changes in exercise intensity and cardiac function with easy implementation, good compliance, and objective and reliable results.It holds great promise in a wide range of purposes such as helping the formulation of exercise prescriptions and evaluating clinical efficacy for cardiac rehabilitation(CR)in community hospitals.
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Introducción: La calibración de los transductores tiene gran importancia para la medición precisa de las presiones, durante la monitorización hemodinámica invasiva de los pacientes que requieren observación estrecha en las unidades de atención al grave y en el quirófano. Objetivo: Desarrollar y validar un método de calibración para transductores de presión, sencillo, eficaz y de bajo costo. Métodos: Se desarrolló un método manométrico alternativo, basado en la ley de Pascal, para la calibración de los transductores de presión durante la monitorización hemodinámica invasiva que se realiza en la Unidad de Cuidados Intensivos de Cirugía Cardiovascular del Hospital Clínico-Quirúrgico Hermanos Ameijeiras. Este método fue validado mediante la comparación con el estándar recomendado en un total de 215 pacientes que requirieron monitorización hemodinámica invasiva entre los meses de enero y junio del 2015. Resultados: Con el método manométrico alternativo creado se obtiene el mismo resultado que con el método hidráulico recomendado por la literatura. Conclusiones: El método alternativo creado es preciso, eficaz y costo-efectivo(AU)
Introduction: Transducer calibration is very important for the accurate measurement of pressures during invasive hemodynamic monitoring of patients requiring close observation in the primary care units and in the operating room. Objective: To develop and validate a method of calibration of pressure transducers, which is simple, efficient and low-cost. Methods: An alternative manometric method, based on Pascal's law, was developed for the calibration of pressure transducers during invasive hemodynamic monitoring performed at the intensive care unit of the cardiovascular surgery department at Hermanos Ameijeiras Clinical-Surgical Hospital. This method was validated by its comparison with the recommended standard in a total of 215 patients who required invasive hemodynamic monitoring between January and June 2015. Results: With the alternative manometric method created, the same result was obtained as with the hydraulic method recommended by the literature. Conclusions: The alternative method created is accurate, efficient and cost-effective(AU)