Application Value Of Noninvasive Hemodynamic Monitoring In Premature Infants With Patent Ductus Arteriosus

Objective:To evaluate the value of noninvasive hemodynamic monitoring in premature infants with patent ductus arteriosus(PDA).Methods:This study is a prospective cohort study,Premature infants with PDA diagnosed three days after birth(gestational age:28~32weeks and birth weight of l000~1800g)admitted to the neonatal intensive care unit(NICU)of our hospital from February1,2017 to October 31,2017 were enrolled in the study.These premature infants were divided into the hsPDA group,the nhsPDA group and the nPDA group by the results of echocardiogram in the first three days and the clinical symptoms.The hsPDA group was checked with echocardiography 24 hours after the standardized medication,and the nhsPDA group received symptomatic treatment.All the infants are checked the HR?Vpk?SVI?MD?CI?MAP and SVRI by using noninvasive hemodynamic monitoring in the postnatal day age 1,3,5 and 7 day age,at the same time every morning.The hemodynamic changes among three groups and the diagnostic value of noninvasive hemodynamic parameters for PDA were analyzed.Results:1.A total of 108 preterm infants were included in the study,of which 77 cases in nPDA group and 31 cases in group PDA.In group PDA,21 cases were hsPDA group and 10 cases in nhsPDA group.In the first 3 days after birth,parameter of Vpk?SVI?MD and CI in the hsPDA group was significantly higher than that in nPDA and nhsPDA groups(P<0.05),SVRI in the hsPDA group was significantly decreased than that in nPDA and nhsPDA groups(P<0.05).There were no significant differences between the non nhsPDA group and the nPDA group in the Vpk?SVI?MD?CI and SVRI(P>0.05).2.In the hsPDA group,after artefial duct was closed,Vpk?SVI?CI and MD decreased to some degree,SVRI increased to some degree,but the difierence had no statistical significance(P>0.05).3.(1)The area under receiver operator characteristic(ROC)curve for prediction of hsPDA by MD?SVI?CI on the 3th day after birth were 0.785?0.788?0.773.(2)The sensitivity and specificity of MD(18.45 m/min)were 86%and69%for hsPDA?The sensitivity and specificity of SVI(19.55 ml/m~2)were67%and 83%for hsPDA?The sensitivity and specificity of CI(2.62L/min/m~2)were 81%and 64%for hsPDA?Conclusions:The hemodynamic changes of hsPDA preterm infants were detected by non-invasive hemodynamic monitoring,and the Vpk,MD,SVI and CI were significantly increased,and SVRI decreased significantly,and improved after treatment.The values of MD,SVI and CI on the third day after birth are of certain clinical value in predicting hsPDA premature infants.