Clinical Study Of Hemodynamic Changes In Children’s Blood Purification

Objective: To monitor the children’s hemodynamic changes by noninvasive hemodynamic monitor during the process of blood purification,to understand the hemodynamic parameters’ changing trend of children,and to analyze the related risk factors.Methods: Selected the children accepted the blood purification in the pediatric intensive care unit(PICU) and department of nephrology and immunology of Children’s Hospital of Chongqing Medical University.Using the ultrasonic cardiac output monitor(USCOM) to monitor the hemodynamic parameters(time points including: before the start of the blood purification, 30 minutes after the starting, first hour after the starting,second hour after the starting and the end of blood purification),including:cardiac index(CI), heart rate(HR), blood pressure(BP), stroke output volume index(SVI), peripheral vascular resistance index(SVRI),et al. And to record the patients’ age, weight, the duration of blood purification, the mode of blood purification, hemoglobin, albumin, concentration of serum potassium and calcium, with or without the preshoot(including the suspension of red blood cells,plasma, human albumin and hydroxyethelstarch),whether hemodynamic intolerance occurred, et al. The children were divided into different groups according to the mode of bloodpurification, ultrafiltration rate, basic cardiac function and initial blood volume. Using SPSS19.0 to analysis data.Results: 1.36 children were included, and had completed 72 blood purification treatments;2.As the blood purification continue, CI, SBP, DBP,MAP, SVI and HR decreased gradually, SVRI increased. Compared with the data before blood purification, CI, SVI, SVRI had significant changes at the point of 30 minutes after starting, and HR changed significantly at the 2nd hour, while SBP,DBP,MAP have no significant changes(P>0.05);3.Compared with the data before blood purification, blood pressure in continuous veno-venous hemodiafiltration(CHDF) and continuous hemofiltration(CHF) group was on the rise, while in blood perfusion(HP),plasma exchange(PE) and hemodialysis(HD) groups was on the decline,the hemodynamic parameters were no statistical difference; 4.Compared to the group free of ultrafiltration and ultrafiltration rate less than 4ml/(kg·h), the children with ultrafiltration rate between 4 to 10 ml/(kg·h)suffered the most significant change in CI,MAP,HR,SVI and SVRI;5.Blood pressure fluctuation was bigger in CI low value group, CI in CI high value group decreased significantly;6. After fully preshoot, there was no significant difference between the Low blood volume group and the normal group in hemodynamic changes.7.There was a significant effect of blood purification duration and ultrafiltration rate on the occurring of hemodynamic intolerance.Conclusion: 1. Hemodynamic changes occurred at 30 minutes after the starting of the blood purification,characterized by declining CI, SVI and increasing SVRI;2. Hemodynamic during blood purification in children was affected by ultrafiltration rate, basic cardiac function and initial blood volume;3. There was a significant effect of blood purification duration and ultrafiltration rate on the occurring of hemodynamic intolerance.