The Clinical Research Of The Volume Parameters Monitored By Uscom To Predicte Fluid Responsiveness In Children After Congenital Heart Disease Surgery

Objective：Monitor the hemodynamic data of the children aftercongenital heart disease（CHD） surgery by USCOM,to understand thechange of pre-load parameters, to compare the veracity of predicting fluidresponsiveness of post-operation children among SVV、FTc、CVP and soon,to understand the pre-load parameters monitored by USCOM can orcannot use in evaluation of the fluid responsiveness of the children aftercongenital heart disease surgery.Method: From June to September2013,data of60patients who hadopen heart surgery for congenital heart disease from the Children s hospitalof Chongqing Medical University. Using USCOM to monitor thepost-operation children admitted in PICU before and after fluid therapy, torecord the HR, the use of inotropic drugs, MAP, CVP, SV, SVI, CI, SVRI,SVV, FTc and SMII, to calculate change of SVI, CVP, FTc,SMII(△SVI,△CVP,△SVV,△FTc,△SMII) and inotropic scores(IS). Children with increased SVI≥15%in response to fluid therapy were considered to beresponders; the remaining ones were defined as non-responders. Twosubgroup: group≤10and group＞10based on IS. Using SPSS17.0toanalysis data, to compare the change of dynamic parameters and thevariations between responders and non-responders; to analysis therelationship between the dynamic parameters,the variations before fluidtherapy and△SVI; using the receiver-operating characteristic curveanalysis to evaluate the diagnostic value.Results:32children had increased SVI with fluid therapy≥15%(responders);28children were defined as non-responders. Thecomparison between responders and non-responders, SVV,△SVV、△SMII had significantly differences. To analysis the relationship betweenCVP, SVV, FTc, SMII,△SVI,△CVP,△SVV,△FTc,△SMII,at baselinewith volume-induced percentage change in SVI, SVV,△CVP,△SVV,△FTc,△SMII were significantly correlated with△SVI. As assessed byreceiver-operating characteristic curve analysis, SVV accurately predictedfluid responsiveness after surgery(AUC:0.776, P＜0.01).Conclusion: SVV monitored by USCOM, in contrast to CVP, FTc,SMII,△CVP, can predict fluid responsiveness in children after congenitalheart surgery.The optimal threshold value given by ROC analysis was17.04%for SVV (sensitivity:84.4%and specificity:60.7%). The differentdose of inotropic drugs caused different optimal threshold value of SVV. △SMII can predict fluid responsiveness with low accuracy, with thethreshold value given by ROC analysis was16%(sensitivity:78.1%andspecificity:64.3%.