超声心排出量检测仪预测脓毒性休克患儿容量反应性的价值

目的 研究超声心排出量检测仪(USCOM)预测脓毒性休克患儿容量反应性的价值.方法 采用前瞻性、观察性队列研究设计方法,选择21例需机械通气的脓毒性休克患儿进行容量负荷试验.在每个试验前后采用USCOM测定每搏输出量(SV)、每搏输出量指数(SVI)、心脏指数(CI)、外周血管阻力指数(SVRI)、每搏变异度(SVV)等血流动力学指标.根据容量负荷试验前后SV的变化(以容量负荷试验后SV增加≥10％为有反应)将患儿分为有反应组和无反应组.采用t检验或x2检验,受试者工作特征曲线(ROC曲线)评价容量负荷试验前SVV、中心静脉压(CVP)预测容量反应性的价值.结果 21例患儿共行容量负荷试验23例次,有反应组13例次,无反应组10例次.容量负荷试验前,有反应组SVV高于无反应组(P=0.003);而2组CVP比较差异无统计学意义(P＞0.05).SVV预测容量反应性的ROC曲线下面积(AUC)为92.4％ (95％ CI:0.821 ～ 1.000,P=0.001),SVV＞ 17.5％时预测容量反应性的敏感度为75.0％,特异度为81.8％.CVP预测容量反应性的AUC为45.8％ (95％ CI:0.206 ～0.710,P=0.742),CVP ＜5.5 cm H2O(1 cm H2O =0.098 kPa)预测容量反应性的敏感度为41.7％,特异度为60.0％.结论 用USCOM测定SVV可反映脓毒性休克机械通气患儿液体治疗时的容量反应性,明显优于CVP等传统指标,可用以指导患儿的液体治疗.     

无创血流动力学监测对儿童脓毒性休克液体复苏容量反应性的预测价值

目的　探讨无创血流动力学监测对脓毒性休克液体复苏容量反应性的预测价值。方法　选取2018年2月至2020年3月于湖南省儿童医院儿童重症监护病房（PICU）确诊的脓毒性休克患儿92例纳入研究, 患儿均给予无创心输出量测量仪床旁监测心脏指数（CI）、 每搏输出量指数（SVI）、 系统血管阻力指数（SVRI）等指标。根据液体复苏治疗前后每搏输出量指数变化率（△SVI）分为有反应组（△SVI≥10%）和无反应组（△SVI＜10%）。观察患儿治疗前后各项血流动力学指标的变化, 并行受试者工作特征（ROC）曲线分析预测儿童脓毒性休克液体复苏容量反应性。 结果　（1）两组患儿年龄、 性别、 感染源及感染部位儿童危重病例评分（PCIS）、 序贯器官衰竭（SOFA）评分、 输液量及机械通气各参数等比较差异均无统计学意义（P＞0.05）, 液体复苏后无反应组较有反应组肺水肿发生率及病死率增高, 住院时间及机械通气时间延长（P＜0.05）。（2）治疗前有反应组患儿CI、 SVI与无反应组比较差异有统计学意义（P＜0.05）［CI（2.55±0.63） L/（min·m2） vs. （3.12±0.75） L/（min·m2）; SVI （35.8±10.3） mL/（min·m2） vs. （40.5±6.3） mL/（min·m2）］, 治疗后CI、 SVI较治疗前明显增高, 心率（HR）、 系统血管阻力指数（SVRI）及每搏变异率（SVV）较治疗前下降, 差异有统计学意义（P＜0.05）, 但胸腔液体水平（TFC）增高不明显（P＞0.05）; 无反应组CI、 SVV、 SVI及SVRI等治疗前后变化不明显（P＞0.05）, 但TFC经液体复苏治疗后明显高于治疗前（P＜0.05）。（3）ROC曲线分析显示SVV, SVI和CI对液体治疗容量反应性有预测价值。SVV, SVI和CI预测液体治疗反应性的AUC分别为0.836（95%CI 0.725～0.947 ）、 0.778（95%CI 0.651～0.905）、 0.793（95%CI 0.663～0.922）（P＜0.005）。且当SVV≥13%时, 其预测液体治疗反应性的敏感度为85.8%,特异度为80.3%, 当SVI≤38 mL/（min·m2）, 其敏感度为81.0%, 特异度为75.8%, 当CI≤2.865 L/（min·m2）时, 其敏感度为78.5%, 特异度为79.2%。结论　无创心输出量测量仪可动态监测无创血流动力学指标, 且SVV、 SVI、 CI可预测儿童脓毒性休克液体治疗的容量反应性, 对指导脓毒性休克早期液体复苏和优化液体管理及预负荷有重要意义,值得临床推广。     

早期监测脑氧饱和度及脑血流参数在脓毒性休克患儿预后中的意义

目的探讨脑氧饱和度(rScO₂)及脑血流参数氧合血红蛋白浓度(ΔO₂Hb)、还原血红蛋白浓度(ΔHHb)和血红蛋白浓度指数(THI)在判断脓毒性休克患儿预后中的价值。方法选择2017年10月—2019年10月收治的脓毒性休克患儿50例。入重症监护病房(ICU)即刻开始监测患儿血流动力学参数,包括平均动脉血压(MAP)、中心静脉压(CVP)、中心静脉血氧饱和度(ScvO₂)和血乳酸,同时监测脑血氧参数rScO₂、ΔO₂Hb、ΔHHb和THI。根据入ICU后28天的预后情况将患儿分为生存组和死亡组,分析两组脑血氧与血流动力学参数。结果共纳入50例脓毒症休克患儿,男31例、女19例,中位年龄4岁;生存组30例,死亡组20例。死亡组APACHEⅡ评分及SOFA评分显著高于生存组,差异均有统计学意义(P<0.05)。初始复苏治疗6小时后,与生存组相比,死亡组MAP、CVP和ScvO₂均显著降低,差异有统计学意义(P<0.05)。生存组及死亡组患儿脑血氧参数rScO₂、ΔO₂Hb、ΔHHb、THI随治疗时间变化的差异有统计学意义(P<0.05),均呈上升趋势。初始复苏治疗后,生存组患儿rScO₂和THI随时间上升较快,显著高于死亡组(P<0.05)。治疗6小时时的rScO₂、ΔO₂Hb与ScvO₂呈显著正相关(P<0.05),而THI与血乳酸水平呈显著负相关(P<0.05)。rScO₂、ΔO₂Hb、ΔHHb、THI诊断脓毒性休克患儿预后的AUC分别为0.765、0.642、0.608和0.718。结论利用近红外光谱技术监测早期脑血氧参数rScO₂、ΔO₂Hb、ΔHHb、THI对判断脓毒性休克患儿的预后有一定价值。     

心输出量监测系统在儿童危重症中的应用研究

目的 通过超声心输出量监测系统(ultrasonic cardiac output monitor,USCOM)记录危重症患儿的每搏心输出量(systolic volume,SV)、心输出量(cardiac output,CO)、外周血管阻力(systemic vascular resistance,SVR)、每搏输出量变量(systolic volume variance,SVV)等变化,了解心功能及血流动力状态.方法 研究对象为依据小儿危重病例评分标准符合危重症病例的11例患儿(观察组)及同期住院的未达到危重症病例标准的20例支气管肺炎患儿(对照组).对2组患儿行USCOM检查,分析2组在心功能及血流动力状态的差异.结果 观察组和对照组CO和SV差异有统计学意义(P＜0.05),SVV和SVR差异无统计学意义(P＞0.05).观察组治疗前后CO、SV、SVV差异有统计学意义(P＜0.05).结论 USCOM可以监测危重病患儿的SV、CO、SVR、SVV等,从而及时掌握患儿循环状态,且操作简便,数据准确,临床上值得推广.     

四氢生物蝶呤负荷试验诊断四氢生物蝶呤反应性苯丙氨酸羟化酶缺乏症的临床研究

目的探讨四氢生物蝶呤(BH4)反应性苯丙氨酸羟化酶(PAH)缺乏症的临床诊断方法,进一步了解其临床特征,为该型患儿应用BH4药物治疗提供科学依据。方法73例高苯丙氨酸血症(HPA)患儿,男47例,女26例,平均年龄1.93个月。所有患儿都进行口服BH4负荷试验,同时进行尿蝶呤谱分析、红细胞二氢蝶啶还原酶测定。对其中血苯丙氨酸(Phe)浓度<600μmol/L者给予口服Phe BH4联合负荷试验,对部分BH4反应性PAH缺乏症患儿,在普食条件下给予BH4片剂(10～20mg/kg)替代治疗6～7天,观察其疗效。结果(1)在BH4负荷试验中,不同类型HPA患儿的血Phe浓度表现出特征性的曲线改变,22例诊断为经典型苯丙酮尿症(PKU),39例中度PKU,12例四氢生物蝶呤缺乏症;(2)在中度PKU患儿中发现22例(56.4%)对BH4有反应;(3)6例BH4反应性PAH缺乏症患儿以BH410mg/kg治疗6～7天,其中4例血Phe浓度能控制到正常或接近正常治疗水平,另2例BH4需增加到20mg/kg使Phe浓度显著下降。结论在BH4负荷试验中,部分因苯丙氨酸羟化酶缺乏引起的中轻度PKU患儿对BH4有反应性,给予这些患儿BH4治疗可部分或全部替代低苯丙氨酸饮食治疗,拓宽了PKU的治疗方法,有助于提高患儿的生活质量。     

氢化可的松治疗先天性肾上腺皮质增生症用药方式探讨

目的了解不同的用药方式对先天性肾上腺皮质增生症(CAH)患儿生长速率及骨龄进展的影响,为选择一种较好的用药方式提供依据。方法对2005—2009年在武汉同济医院儿科遗传代谢内分泌专科门诊就诊的18例CAH患儿(男9例,女9例)进行回顾性分析。根据氢化可的松用药方式不同分为A组(自2007年5月开始用药,用药方式为新方式,即每天用药3次,早8时和下午4时均服用全天总量的1/4,晚10时左右服用全天总量的1/2。)和B组(用药为2007年5月前用旧方式而2007年5月后改用新方式,旧方式即全天总量分2次或1次服用),B组又根据前后用药方式的改变分为B1组(旧方式组)和B2组(新方式组),分别比较A组和B1组、B1组和B2组年生长速率(GV)、身高年龄增长(ΔHA)、ΔHA与骨龄增长(ΔBA)间的关系(ΔHA/ΔBA)以及骨龄变化与实际年龄变化的比值(ΔBA/ΔCA)的差异。结果 A组和B1组、B2组和B1组相比,△BA/△CA的值均显著降低(P0.05),ΔHA与ΔHA/ΔBA的值差异均无统计学意义(P0.05)。A组和B1组的GV差异无统计学意义(P0.05),但B2组和B1组相比,GV显著降低(P0.05)。结论患儿以新方式用药在抑制骨龄进展和保持正常生长方面明显优于旧方式,新方式用药可增加患儿身高增长空间,提高患儿终身高。     

咳嗽变异性哮喘患儿气道反应性特点

目的了解咳嗽变异性哮喘(CVA)患儿气道反应性特点。方法对38例CVA患儿、42例典型哮喘患儿和30例健康儿童进行肺功能和气道反应性测定。结果 CVA组和典型哮喘组患儿的气道反应性测定中的初始阻力值(Rrs cont)、基础呼吸传导率(Grs cont)与对照组比较差异无统计学意义;而最小诱发累积剂量(Dmin)、传导率下降斜率(SGr)和特异性气道传导下降第35百分位(PD35)均低于对照组,差异有统计学意义(P<0.05)。结论 CVA与典型哮喘患儿气道敏感性和气道反应性高于正常儿童,存在气道高反应。气道反应性测定可成为鉴别诊断慢性咳嗽的重要方法之一。     

N末端脑钠肽前体诊断不完全川崎病急性期临床意义

目的观察血浆中N末端脑钠肽前体(NT-pro BNP)水平在不完全川崎病(IKD)急性期的变化,探讨其在IKD中的诊断意义,并进一步研究NT-pro BNP对早期预测川崎病静脉注射丙种球蛋白(IVIG)无反应的作用。方法选取2013年7月至2014年12月在华中科技大学同济医学院附属同济医院儿科住院治疗的川崎病患儿239例,其中典型川崎病(TKD)110例,IKD129例,分别于急性期采取血样本,检测血浆中NT-pro BNP水平,同时检测血白细胞计数、中性粒细胞比例、血小板计数、C反应蛋白(CRP)、红细胞沉降率(ESR)、丙氨酸转移酶(ALT)、天冬氨酸转移酶(AST)以及白蛋白水平,并选取同期65例呼吸道感染患儿作为对照组,运用方差分析比较3组之间的差异。同时运用ROC曲线分析评价NT-pro BNP对川崎病的诊断意义,并与其他差异具有统计学意义的检测项目进行对比。所有川崎病患儿入院后均给予IVIG 2 g/kg及口服阿司匹林治疗,运用t检验比较IVIG无反应组与敏感组之间血浆NT-pro BNP水平的差异。结果 IKD患儿急性期NT-pro BNP水平为(796.24±1324.26)ng/L,明显高于对照组[(168.85±208.24)ng/L,P0.05],与TKD患儿NT-pro BNP水平[(1362.70±2576.49)ng/L]比较,差异无统计学意义。NT-pro BNP诊断川崎病ROC曲线下面积(AUC)为0.786,取临界值191.5 ng/L时,灵敏度和特异度分别为70.0%和76.9%,与白蛋白、血白细胞计数、CRP以及ESR结果相近。IVIG无反应组和敏感组NT-pro BNP水平分别为(1215.15±1663.33)ng/L和(1043.66±2056.45)ng/L,两组比较差异无统计学意义(P=0.700)。结论血浆中NT-pro BNP在IKD急性期显著增高,可作为早期诊断IKD的参考指标之一,但对早期预测川崎病IVIG无反应无明显作用。     

大剂量静脉注射丙种球蛋白无反应性川崎病的临床分析

目的 探讨对大剂量静脉注射丙种球蛋白(IVIG)无反应性川崎病的发生率及临床特点,以及再治疗方案的选择.方法 回顾性总结2000年1月至2006年12月入院的KD患儿的临床资料,根据对首次大剂量IVIG有无反应分成IVIG敏感组和无反应组,比较两组的临床特点.结果 诊断为川崎病并接受IVIG治疗患儿222例,其中IVIG敏感者185例,无反应者37例,发生率16.67%(37/222).无反应组接受IVIG治疗时间早,发热时间长,住院时间长,白细胞总数、中性粒细胞比值、CRP明显高于敏感组,而血浆白蛋白明显低于敏感组.IVIG无反应组合并冠状动脉病变14例(37.84%),明显高于IVIG敏感组(15.68%).IVIG无反应组合并噬血细胞综合征2例,多发性冠状动脉瘤及心肌梗死者1例,多脏器功能衰竭死亡1例.对IVIG无反应者的冉治疗,给予IVIG追加疗法,甲基泼尼松龙冲击治疗,泼尼松口服治疗.结论 IVIG无反应性川崎病较IVIG敏感性川崎病更易发生冠状动脉病变和严重并发症;接受IVIG治疗时间、发热时间、中性粒细胞比值、CRP、血浆白蛋白是IVIG无反应的危险因素.对IVIG无反应性川崎病可以用IVIG追加治疗,无效者选用糖皮质激素.     

新生儿呼吸支持中呼气末二氧化碳分压的监测意义

目的比较无创面罩、经鼻导管及有创机械通气三种方法监测的新生儿呼气末二氧化碳分压(end tidal carbon dioxide pressure,PetCO₂)及其与动脉血二氧化碳分压(arterial carbon dioxide pressure,PaCO₂)的相关性。方法选取2017年10月至2020年1月在我院新生儿科住院期间需呼吸支持治疗的患儿53例,分别监测患儿入院时、呼吸支持时及病情好转撤机后的PetCO₂,包括经鼻导管、无创面罩及有创通气时三种方式监测PetCO₂,并同时配对分析相应患儿动脉血血气分析中的PaCO₂。结果(1)无创面罩监测的PetCO₂低于PaCO₂[(40.41±10.21)mmHg比(42.85±10.32)mmHg(1 mmHg=0.133 kPa),t=11.88,P<0.01],两者之间呈显著的正相关性(r=0.97,P<0.01);无创面罩监测的PetCO₂偏倚平均值是(1.20±2.31)mmHg,仅4.5%(5/110)在95%CI以外。(2)经鼻导管监测的PetCO₂也低于PaCO₂均值[(40.93±10.55)mmHg比(42.01±10.50)mmHg,t=4.12,P<0.01],两者之间呈显著的正相关性(r=0.96,P<0.01);经鼻导管监测的PetCO₂偏倚平均值是(2.44±2.56)mmHg,仅4.6%(7/150)在95%CI以外。(3)气管插管机械通气患儿的PetCO₂同样低于PaCO₂[(43.33±10.26)mmHg比(49.37±11.34)mmHg,t=13.83,P<0.01],两者之间同样呈显著的正相关性,相关性较无创通气患儿偏低(r=0.94,P<0.01);有创正压通气患儿的PetCO₂偏倚平均值是(0.90±0.82)mmHg,仅3.9%(2/51)在95%CI以外。(4)按胎龄分组,早期早产儿和晚期早产儿的PetCO₂分别为(37.25±11.32)mmHg和(39.58±10.37)mmHg,均低于足月儿PetCO₂[(42.69±10.66)mmHg],三组患儿的PetCO₂与PaCO₂均呈正相关;早期早产儿的PetCO₂与PaCO₂相关性为三组中最低(r=0.89,P<0.01)。结论经鼻导管、无创面罩及有创通气时监测PetCO₂均与患儿的PaCO₂有较好的相关性和一致性,能较准确地反映患儿PaCO₂水平,其中无创通气患儿PetCO₂和PaCO₂的相关性优于有创通气患儿;晚期早产儿和足月儿的PetCO₂与PaCO₂相关性优于早期早产儿。     

The Ability of Stroke Volume Variation Measured by a Noninvasive Cardiac Output Monitor to Predict Fluid Responsiveness in Mechanically Ventilated Children

Continuous noninvasive cardiac output monitoring (NICOM) is a clinically useful tool in the pediatric setting. This study compared the ability of stroke volume variation (SVV) measured by NICOM with that of respiratory variations in the velocity of aortic blood flow (△Vpeak) and central venous pressure (CVP) to predict of fluid responsiveness in mechanically ventilated children after ventricular septal defect repair. The study investigated 26 mechanically ventilated children after the completion of surgery. At 30 min after their arrival in an intensive care unit, a colloid solution of 10 ml/kg was administrated for volume expansion. Hemodynamic variables, including CVP, stroke volume, and △Vpeak in addition to cardiac output and SVV in NICOM were measured before and 10 min after volume expansion. The patients with a stroke volume increase of more than 15 % after volume expansion were defined as responders. The 26 patients in the study consisted of 13 responders and 13 nonresponders. Before volume expansion, △Vpeak and SVV were higher in the responders (both p values <0.001). The areas under the receiver operating characteristic curves of △Vpeak, SVV, and CVP were respectively 0.956 (95 % CI 0.885–1.00), 0.888 (95 % CI 0.764–1.00), and 0.331 (95 % CI 0.123–0.540). This study showed that SVV by NICOM and △Vpeak by echocardiography, but not CVP, reliably predicted fluid responsiveness during mechanical ventilation after ventricular septal defect repair in children.     

Pilot study on the feasibility of limited focused real‐time echocardiography during pediatric renal transplantation

Pediatric renal transplantation protocols describe supraphysiological blood pressure and CVP to optimize graft perfusion. Ideal CVP and blood pressure targets in children are uncertain and difficult to achieve and/or sustain without incurring morbidity. We correlated intra‐operative ECHO with standard monitoring to assess intravascular volume at critical intra‐operative stages. A feasibility pilot study of real‐time limited ECHO images during four critical stages of pediatric renal transplantation (baseline; venous and arterial clamps on; clamps off; 5–10 min post‐clamp release) was conducted. Simultaneous CVP, SBP and DBP measurements were obtained with ECHO images. A surgeon blinded to the ECHO study assessed the quality of graft perfusion. Thirteen patients (nine TTE and four TEE) were enrolled. The CI increased in all patients at vascular clamp removal and the post‐resuscitation period (average increase in CI 20%, range 8–49%). SBP, DBP and CVP were inconsistent. ECHO data confirmed an appropriate CI increase even when the targeted CVP and BP values described in protocols were not achieved. The surgeons were satisfied with graft perfusion in 12 of 13 cases, with one locally obstructed vessel. We suggested that aiming for fixed targets in CVP and BP is not necessary to augment CI and encourage good renal perfusion.     

Echocardiographic Inferior Vena Cava Measurement As An Alternative to Central Venous Pressure Measurement in Neonates

Objectives

To evaluate the correlation between echocardiographic inferior vena cava (IVC) measurements and central venous pressure (CVP) in neonates. Also, to evaluate the correlation between IVC measurements and gestational age (GA) and body weight (BW).

Methods

This cross sectional analytical study was conducted from June 2014 through June 2016 in a level III NICU. All neonates requiring intensive hemodynamic monitoring and having umbilical venous catheter (UVC) in place for clinical indications were enrolled in the study. IVC measurements were recorded by echocardiography (ECHO) and CVP was measured concomitantly in neonates having appropriate sized UVC in place. IVC measurements were evaluated and compared for any correlation with the CVP, GA and BW.

Results

Fifty neonates with median gestation of 37 wk [Q1 = 29.2, Q3 = 37.8, interquartile range (IQR) = 8.6 wk] and median birth weight of 2420 g (Q1 = 923.5, Q3 = 2850, IQR = 1926.5 g) were included in the study. A strong negative linear correlation was observed between IVC collapsibility index (IVC-CI) and CVP (r = ?0.968, r² = ?0.937, p 0.000). No correlation was observed between IVC-CI and GA or BW. IVC minimum and IVC maximum diameters did not correlate with CVP but correlated well with GA and BW.

Conclusions

Echocardiographic IVC-CI measurement has a good correlation with CVP measurement in neonates. The clinical use will depend on the ability of IVC-CI to predict surrogate markers of tissue perfusion in shock.

     

Respiratory Variation in Aortic Blood Flow Velocity as a Predictor of Fluid Responsiveness in Children After Repair of Ventricular Septal Defect

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.     

The Correlation Between Inferior Vena Cava Diameter Measured by Ultrasonography and Central Venous Pressure

Objective

To find a correlation between inferior vena cava (IVC) diameters, IVC compressibility index (CI) and central venous pressure (CVP).

Methods

Prospective observational study was done at pediatric intensive care unit (PICU) of Kalawati Saran Children’s Hospital (KSCH). Fifty children aged 5-18 y, presenting with shock were enrolled for the study. IVC diameters, CI and relevant clinical data were noted at enrollment, 30 min, 1 h, 6 h, and 12 h. Central line was placed at the time of admission.

Results

Of 50 children enrolled, 28 were boys, with a mean age of 11 y. More than 80% of cases were diagnosed as septic shock. Mean maximum and minimum IVC diameter of 8.3 ± 2 mm and 3.7 ± 1.7 mm, respectively CI 58.2 ± 7% and CVP of 5.4 ± 1.5 cm of H₂O was observed at admission. CVP and IVC diameters showed a serial improvement with treatment; CI showed a serial decrease with treatment. Heart rate (HR) and systolic blood pressure (SBP) also showed a serial improvement at 12 h (p < 0.05). CVP showed a positive correlation with IVC diameter (r +0.312; p < 0.05), and a negative correlation with CI (r ?0.343; p < 0.05).

Conclusions

Effective fluid resuscitation improves IVC diameters with a decrease in CI. IVC diameter has a positive correlation to CVP and CI has a negative correlation to CVP.

     

Estimation of Right Atrial Pressure from the Inspiratory Collapse of the Inferior Vena cava in Pediatric Patients

Objective

Paucity of data exists between mean right atrial pressure (RAP) and inferior vena cava (IVC) size and collapsibility in pediatric patients with congenital heart disease.

Methods

In a prospective study, fifty consecutive pediatric patients with different congenital heart diseases who had right side cardiac catheterization were studied, comparing right atrial pressure with simultaneous M-mode echocardiographic measurement of inferior vena cava diameter. Mean age of the patients was 4.96±4.05 years (30 male and 20 female). Patients were categorized into two groups according to their right atrial pressure (RAP) as measured by cardiac catheterization: Group 1 (40 patients) were those with mean RAP <8 mmHg and group 2 (10 patients) who had a mean RAP≥ 8 mmHg.

Findings

In M-mode echocardiography IVC size was statistically different (P=0.004 and 0.009) in inspiration and expiration in the two groups. Mean RAP was estimated to be>8 mmHg when IVC diameter in inspiration was >3.6 (sensitivity of 100%, specificity of 47.5%, +LR=1.9) or if IVC diameter was >6mm in expiration (sensitivity of 70%, specificity of 87%, +LR=4.67).

Conclusion

This study showed that measurement of IVC size in inspiration and expiration can be used as a reliable method for estimation of mean right atrial pressure.     

血浆IL-6与IL-27在鉴别早产儿急性呼吸窘迫综合征与呼吸窘迫综合征的初步研究北大核心CSCD

目的 探讨血浆白细胞介素(interleukin,IL)-6、IL-27在鉴别早产儿急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)及新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)中的价值。方法 前瞻性纳入2021年3~11月重庆医科大学附属儿童医院新生儿诊治中心具有呼吸窘迫表现的早产儿,根据诊断结果分为ARDS组(n=18)及NRDS组(n=20)。采用酶联免疫吸附试验法检测患儿血浆IL-6和IL-27水平,受试者工作特征(receiver operating characteristic,ROC)曲线分析各指标诊断ARDS的价值。结果 ARDS组血浆IL-6及IL-27水平均高于NRDS组(P<0.05)。ROC曲线分析显示:当IL-6取56.21 pg/m L时,曲线下面积、灵敏度和特异度分别为0.867、61.1%、95.0%;当IL-27取135.8 pg/m L时,曲线下面积、灵敏度和特异度分别为0.881、83.3%、80.0%。结论 血浆IL-6和IL-27可作为早期鉴别早产儿ARDS与NRDS的生物学指标。     

Evidence that the renal response to volume expansion involves a blood-borne factor.

The effect of blood volume expansion in immature rats by blood from infants (J to J expansion) and mature animals (A to J) has been studied. A to J expansion results in an increased renal response to expansion which is greater than J to J, but not as great as when mature animals are expanded with blood from other matures (A to A) or pooled blood from infants (J to A). A to A and J to A expansions show no significant differences in renal responsiveness. The lack of an immature response is not due to differences in animal hydration since 2.5% volume expansion is on the flat part of dose response curve. Part of the scatter of the adult response is related to absolute levels of GFR which might indicate the existence of a filterable natriuretic factor or, alternatively, a dependence of renal responsiveness on filtered load. These results are interpreted to indicate that mature rats contain a natriuretic factor or an inhibitor of an antinatriuretic factor which is blood borne and is probably secreted in blood volume expanded rats.