Application value evaluation of bedside non-invasive hemodynamic monitoring in the perioperative management of neonatal gastrointestinal surgery / 中国小儿急救医学

ABSTRACT

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.