Application value of bedside noninvasive hemodynamic monitoring in the diagnosis and treatment of neonatal septic shock / 中华实用儿科临床杂志

ABSTRACT

Objective To evaluate the application value of bedside noninvasive hemodynamic monitoring in the diagnosis and treatment of neonatal septic shock.Methods The purchase time and use of Ultrasound Cardiac Output Monitor (USCOM) to monitor hemodynamic status were taken as the grouping condition,and the infants admitted to Department of Neonatology in Shanghai Children's Hospital from March 2014 to December 2016 were divided into 3 groups,16 of USCOM's pre-purchased septic shock infants were taken as non-USCOM monitoring group,20 patients with septic shock received USCOM monitoring as USCOM monitoring group,the other 20 non-septic shock neonates were assigned as a control group,whose primary diseases were premature,neonatal jaundice or neonatal pneumonia.Systolic volume (SV),cardiac output (CO),heart rate (HR),cardiac index (CI) and systemic vascular resistance index (SVRI) in USCOM monitoring group and control group were recorded.The doses of dopamine,dobutamine,epinephrine or norepinephrine and the time of vasoactive drug administration were compared between the USCOM monitoring group and non-USCOM monitoring group.The data of 3 groups were analyzed statistically.Results Compared with the control group,the hemodynamic parameters of the USCOM monitoring group before treatment such as CO [(0.68 ± 0.44)L/min vs.(0.44 ± 0.17) L/min,t =3.306,P =0.004],CI [(4.40 ± 1.88) L/(min · m2) vs.(3.00 ±0.40) L/(min · m2),t =3.328,P =0.004],SV [(3.90 ±2.39) cm3 vs.(3.08 ±0.31) cm3,t =2.227,P =0.038]and HR [(166.09 ± 26.20) times/min vs.(145.35 ± 16.16) times/min,t =2.750,P =0.013] were increased,while the SVRI showed an obvious decline [(795.88 ± 450.19) d · s/(cm5 · m2) vs.(1 160.61 ± 49.59)d · s/(cm5 · m2),t =-2.898,P =0.009],and the differences were statistically significant.While in the USCOM monitoring group after treatment,the CO [(0.56 ± 0.28) L/min vs.(0.68 ± 0.44) L/min,t =2.456,P =0.024] and CI [(3.65 ± 1.10) L/ (min · m2) vs.(4.40 ± 1.88) L/ (min · m2),t =2.614,P =0.017] were decreased significantly compared with those in USCOM monitoring group before treatment.Compared with non-USCOM monitoring group,the doses of dopamine [(45.72 ± 28.80) mg/kg vs.(85.83 ± 69.33) mg/kg,t =2.352,P =0.005],dobutamine [(12.81 ±26.18) mg/kg vs.(85.83 ±69.33) mg/kg,t =4.351,P =0.002],epinephrine [(0.11 ±0.33) mg/kg vs.(0.90± 1.75) mg/kg,t=1.986,P =0.014],and the time of vasoactive drug use [(68.10 ±34.37) h vs.(167.75 ± 117.14) h,t =3.626,P =0.001] were decreased significantly in USCOM monitoring group.The doses of norepinephrine [(1.91 ± 3.79) mg/kg vs.(0.47 ± 0.90) mg/kg,t =-1.481,P =0.046] were increased significantly in USCOM monitoring group.Conclusion The noninvasive hemodynamic monitoring plays an important role in the diagnosis and treatment of septic shock in neonates by clarifying the hemodynamic status of shock and guiding the rational use of vasoactive drugs so as to improve the successful rescue rate.