Hemodynamics in Preterm Infants with Late-Onset Sepsis
Hemodynamics in Preterm Infants with Late-Onset Sepsis
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DOI：
10.1016/j.jpeds.2009.12.026
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发表时间：
2010-06-01
影响因子：
5.1
通讯作者：
Evans, Nick
中科院分区：
文献类型：
--
作者：
de Waal, Koert;Evans, Nick
目的探讨临床脓毒症早产儿血流动力学随时间的变化。研究设计：每12小时测量一次疑似感染并表现出心血管损害迹象的婴儿的血压、右心室输出量（RVO）、左心室输出量（LVO）和上腔静脉（SVC）流量，直至认为临床改善。结果20例中位胎龄27周（范围25 ~ 32周），体重995 g（范围650 ~ 1980 g）的新生儿。5名患者死亡。第一次测量时RVO、LVO和SVC的平均（SD）流量分别为555（133）、441（164）和104 (39)mL/kg/min。计算的全身血管阻力（SVR）为0.08 (0.04)mm Hg/mL/kg/min。15名幸存婴儿的血流量没有明显变化。血压和SVR从第一次测量到最后一次测量（平均差值：血压，8 mm Hg； 95% CI 3至-13；全身血管阻力，0.02 mm Hg/mL/kg/min; 95% CI， 0.01至-0.04）。5名未存活婴儿的流量减少，SVR增加（平均差异：RVO， -318 mL/kg/min; 95% CI， -463至-174；LVO, -292 mL/kg/min; 95% CI， -473至-111；SVC流量，-46 mL/kg/min; 95% CI， -77至-16）。结论脓毒症早产儿左、右心输出量较高，SVRs较低。与初始测量值相比，RVO或LVO bb0降低50%与死亡率相关。[J] .儿科杂志2010；56:918-22。
Objective To describe the hemodynamic changes with time in preterm infants with clinical sepsis.Study design Blood pressure, right ventricular output (RVO), left ventricular output (LVO), and superior vena cava (SVC) flow of infants who had a suspected infection and showed signs of cardiovascular compromise were measured every 12 hours or until there was considered clinical improvement.Results Twenty infants with a median gestational age of 27 weeks (range, 25-32 weeks) and weight of 995 g (range, 650-1980 g) were examined. Five patients died. The mean (SD) RVO, LVO, and SVC flow at the first measurement were 555 (133), 441 (164), and 104 (39) mL/kg/min, respectively. The calculated systemic vascular resistance (SVR) was 0.08 (0.04) mm Hg/mL/kg/min. There was no significant change in flow in the 15 surviving infants. Blood pressure and SVR increased from the first to the last measurement (mean difference: blood pressure, 8 mm Hg; 95% CI 3 to -13; systemic vascular resistance, 0.02 mm Hg/mL/kg/min; 95% CI, 0.01 to -0.04). Flows decreased and SVR increased in the 5 non-surviving infants (mean difference: RVO, -318 mL/kg/min; 95% CI, -463 to -174; LVO, -292 mL/kg/min; 95% CI, -473 to -111; SVC flow, -46 mL/kg/min; 95% CI, -77 to -16).Conclusion Preterm neonates with sepsis have relatively high left and right cardiac outputs and low SVRs. A decrease in RVO or LVO > 50% compared with the initial measurement is associated with mortality. (J Pediatr 2010;156:918-22).