Clinical Application Of Transpulmonary Thermodilution Method In Monitoring In Infants After Cardiac Surgery

Object:Through the clinical application of transpulmonary thermodilution in infants after cardiac surgery with congenital heart disease①Ttry to validate GEDVI as cardiac preload in early period (in 48 hours) postoperative of congenital heart disease.②Observe the CI changes in early period (in 48 hours) postoperative of congenital heart disease, so as to guide a more reliable and effective clinical treatment.Patients and method:Include criteria:infants(less than 3 years old)who underwent cardiac surgery with bypass for congenital heart disease in ZheJiang Univertisy affiliated children's hospitiabetween August 2009 and April 2010.Ruled out criteria:the femoral artery puncture or thermal dilution catheter insertion contraindications, cardiac shunt or severe cardiac valve insufficiency.18 cases were selected including simple ventricular septal defect (VSD) 6 cases (VSD group); ventricular septal defect with pulmonary hypertension (VSD+PH) 6 cases, (VSD+PH group); tetralogy of Fallot (TOF) 6 cases (TOF group).Insert jugular central venous catheter preoperation; Place left atrium catheter intraoperation. When was transported to SICU, PiCCO thermodilution catheter was placed into femoral artery.Then use TPTD method Rapidly inject 3-5ml 4℃saline into the central venous catheter for three times and then write down the averaged indicates to record CI, GEDVI, meanwhile, recorded the LAP and CVP value at 6 interval times (0,4,8,12,24,48h) postoperation.Statistical AnalysisAll statistical analysis was computed by SPSS 16.0 software. All data are expressed as mean values standard deviations (mean±SD). All hemodynamic and volumetric data obtained were analyzed with analysis of variance for repeated measurements and LSD. Statistical significance was considered to be at P<0.05.Results:1. All of the 18 cases were discharged, did not occur complications such as bleeding, infection, arrhythmia, thrombosis, limb ischemia because of the catheter placement, removement or occurrence during the study period.2. Infants with congenital heart disease in postoperative period GEDVI was significantly correlated with SVI, better than the correlation of LAP with SVI while CVP was significantly correlated with SVI. In VSD group GEDVI was significantly correlation with SVI, better than CVP, LAP. In VSD+PH group GEDVI was significantly correlated with SVI, better than the correlation of LAP with SVI while CVP was not significantly correlated with SVI. In TOF group GEDVI was significantly correlated with SVI, while CVP and LAP was not significantly correlated with SVI.3. CI value in infants with congenital heart disease gradually decreased within the first 12 h postoperatively, and at the point of 24h,48h postoperatively it has upward trend compared with before, CI values of 48 postoperatively increased significantly compared to the CI values of 0,4h,8h,12h postoperatively. (P<0.05).4. Grouped CI changes:CI values of VSD group is higher than VSD+PH group and the TOF group, all the time points of the CI values were significantly higher than the TOF group (P<0.05), and CI value of 12h postoperatively was significantly higher than the VSD+PH group (P<0.05). CI value of VSD+PH group was higher than the CI value of TOF group, but only the point of 8h postoperatively significant differences (P<0.05).In VSD group the CI value changed insignificantly by time. In the VSD+PH group,the CI value gradually decreased within the first 12 h postoperatively and 24,48h, it has upward trend compared with before.,and the CI value of 48h postoperatively increased significantly compared to 12h postoperatively (P<0.05).In the TOF group,CI value is the lowest at the 8 and 12 h postoperatively, and at the 24h and 48h, it has upward trend compared with before,CI values of 48h postoperatively increased significantly compared to the CI values of 0,4h,8h,12h postoperatively (P<0.05).Conclusion:1. In VSD group GEDVI was significantly correlated with SVI, better than CVP and LAP; In VSD+PH group GEDVI was significantly correlated with SVI, CVP and LAP was not correlated with SVI. than CVP, LAP.GEDVI was more accurately reflect cardiac preload.2. Parameters monitored by TPTD can accurately reflects the circulation situation in infants with congenital heart after cardiac surgery.