| PART 1:Study of effect and optimal duration of positive inotropic drugs on the prevention of low cardiac output symptom in children with simple congenital heart disease by PRAMBackgroudFor simple congenital heart disease(CHD),open heart surgery under cardiopulmonary bypass is often used.The clinical routine is to prevent low cardiac output syndrome(LCOS)after CHD by intravenous injection of dopamine and milrinone.However,there is no generally accepted stopping guideline for prophylactic use of positive inotropic drugs in clinical practice,which is often stopped by clinicians based on experience or gradually reduced.ObjectiveTo study the safety of early discontinuation of the positive inotropic drugs in children with simple CHD after open-heart surgery.To compare the effects of early discontinuation of positive inotropic drugs and preventive use of positive inotropic drugs on postoperative hemodynamics of children with simple congenital heart disease and determine the optimal duration of positive inotropic drugs.Methods84 children with simple CHD diagnosed by echocardiography in Guangzhou Women’s and children’s medical center from March 5,2019 to August 25,2019 were included in the prospective randomized controlled study.All cases were performed under the fast channel anesthesia and cardiopulmonary bypass(CPB).After the operation,esophageal ultrasound was performed to confirm the success of the operation and transferred to the cardiac intensive care unit(CICU).The children were randomly divided into four groups:1.5h group,3h group,6h group(corresponding to 1.5h,3h,6h after returning to CICU)and control group(corresponding to 24h after returning to CICU).The hemodynamic indexes were monitored by PRAM for 24 hours.The general data,hemodynamic indexes,arterial and venous blood gas analysis results,echocardiography results,clinical manifestations of LCOS and adverse drug reactions were recorded and analyzed at 1H,3h,6h,9h,12h,18h and 24h after entering CICU.ResultThere were 21 cases in 1.5h group,3h group,6h group and control group respectively.There was no statistical difference in the general data of the four groups(P>0.05).There was no significant difference in hemodynamic indexes,the blood gas analysis results(SvO2,pH,lac and Be-B),and echocardiographic results(EF,FS,LVDD)1 day after sugery among the 1.5h group,3h group,6h group and the control group(P>0.05).There was interaction between group and time in HR and RPP of 1.5h group and control grup(P<0.05).There was interaction between group and time in RPP、CCE、HR、DBP、MAP of 6h group and control grup(P<0.05).The SBP of 3h group was higher and SVRI was lower than those 1h later after stop using positive inotropic drugs(P<0.05,respectively).The DBP,HR and RPP of 6h group were lower than those of 1h group later after stop using positive inotropic drugs(P<0.05,respectively).ConclusionsIt is safe and feasible to stop using positive inotropic drugs early after operation in children with simple CHD ultrafast channel anesthesia.Early discontinuation of positive inotropic drugs can reduce myocardial oxygen consumption.The proper time of prophylactic use of positive inotropic drugs was less than 6 hours after surgery.PART 2:The study of hemodynamic change trends and correlativity of postoperative children with complex congenital heart disease by PRAMBackgroundCongenital heart disease(CHD)is a congenital malformation caused by the abnormal development of heart and large blood vessels in the fetal period,and also one of the main causes of infant death.For complex congenital heart disease,surgical treatment is often used to correct intracardiac malformation.The common complication after cardiac surgery is low cardiac output syndrome(LCOS).It has been reported that the incidence of LCOS after complex CHD is as high as 25%.The risk of death in neonates,infants and children with LCOS after CHD is greatly increased.It is often not accurate for clinicians to judge hemodynamicsby patients’ heart rate,blood pressure,central venous pressure and organ perfusion.To evaluate the hemodynamic changes and related factors of children with CHD by hemodynamic indexes will help clinicians to better implement reasonable liquid therapy and drug therapy,which has important clinical value.To explore the hemodynamic changes and its related factors in children with complicated CHD after operation can provide reasonable guidance of fluid therapy and drug therapy for cliniciansObjectiveObserved the hemodynamic changes of postoperative children with complex CHD by PRAM.Analyze the hemodynamic change trends and their relationship,so as to provide clinicians with reasonable guidance of liquid therapy and drug therapyMethodsFrom July 2019 to December 2019,54 children with complex CHD diagnosed by echocardiography and successfully operated in our hospital were selected for observation study.All the children returned to CICU after operation were monitored by the mostcare monitor(PRAM),and the hemodynamic index were recorded immediately(0h),4h,8h,12h,16h,20h,24h,36h and 48h after entering CICU,as well as the results after the children returned to CICU.To analyze the trend of hemodynamics and their relationship in children with complicated CHD.ResultAmong the 46 patients with complex congenital heart disease,8(17%)of them presented LCOS,of which 5(11%)presented CI≤2 L/(min·m2),and 3(6%)presented clinical manifestations of LCOS such as oliguria and wet and cold extremities.The trend of DBP in children with complex CHD is different in different time periods.DBP at T1 was lower than DBP at Oh(P<0.05),8 and 12h after arrived at CICU.DBP at Oh was higher than DBP at 24h,36h and 48h(P<0.05,respectively)after arrived at CICU.CI decreased significantly in the early postoperative period,reached the lowest level at 4h after arrived at CICU,then increased,and reached a high value at 12h after arrived at CICU.CI at 4h after arrived at CICU was significantly lower than Oh and 16h(P<0.05,respectively).The overall trend of CCE increased after arrived at CICU.CCE at Oh was significantly lower than that at 20h,36h and 48h(P<0.05,respectively)after arrived at CICU.PPV showed a decreasing trend after the operation.PPV at 36h was significantly lower than that Oh(P<0.05)arrived at CICU.SVRI showed a downward trend and SVRI at Oh was significantly higher than 12h,20h and 24h(P<0.05,respectively).After the operation,dp/dtmax showed a downward trend,reached the lowest point at 4h,and then an upward trend,and was significantly higher than T1 at 20h,24h,and 48h(P<0.05,respectively).CI was positively correlated with DBP,PPV and negatively correlated with HR.CCE was positively correlated with dp/dtmax and negatively correlated with DBP.ConclusionsCI and dp/dtmax at 4h were the lowest after operation in the children with complicated CHD.PPV was higher than normal value in the first 24h after operation,which means the necessity of early use of positive inotropic drugs and volume administration. |
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