Clinical Study On Cardiac Function And Hemodynamics In Infant Pneumonia By USCOM

Objective:To study on the cardiac function and hemodynamics of infantpneumonia by ultrasonic cardiac output monitor(USCOM),and to analyze the correlation between myocardial injury index,inflammatory index and cardiac functionin severe infant pneumonia.Methods:The data of 74 infantpneumoniain pediatrics Affiliated Hospital of North Sichuan Medical College from October 2018 to January 2020 were collected and divided into two groups:mild pneumonia group(n=45)and severe pneumonia group(n=29),The cardiac function and hemodynamics of the two groups was measured by USCOM,including heart rate(HR),Flow time Corrected(FTc),Stroke Volume Variability(SVV),stroke output index(SVI),heart index(CI),Inotropy Index(INO),peripheral vascular resistance index(SVRI).According to the specific valuesof CI and SVRI in all ages,the types of hemodynamics were distinguished,CI were grouped into normal,high and low output,SVRI were grouped into normal,high and low resistance.The cardiac function and hemodynamic status of infants with pneumonia in each group were compared.In addition,WBC,PCT,CRP,hs-cTnT,CK-MB,ALT Cr,LAC and pH were collected.To analyze the correlation between myocardial injury markers(hs-cTnT,CK-MB),inflammation markers(WBC,PCT,CRP)and cardiac function in infants with severe Pneumonia.Results:1.In the mild pneumonia group,42.22%of the infants presented abnormal hemodynamic status,of which 94.74%were high-output and low-resistance type.In severe pneumonia group,79.31%of the infants presented abnormal hemodynamic status,of which 86.96%were not high-output and low-resistance type,showing different hemodynamic types such as low-output and high-resistance(39.13%),high-output and normal-resistance(26.09%),low-output and low-resistance(13.04%)and normal-output and low-resistance(8.70%).Before treatment,Stroke volume index,Cardiac index and Inotropy of severe pneumonia group were lower than those of mild pneumonia group,and the heart rate and cardiac afterload were higher than those of mild pneumonia group(P<0.05).There was no significant difference in cardiac preload between the two groups before treatment(P>0.05).After treatment,the heart rate of the severe pneumonia group was lower than that before treatment,and the Stroke volume index,cardiac index were higher than that before treatment(P<0.05).There was no statistically significant difference in cardiac preload before and after treatment(P>0.05).2.hs-cTnT level(0.10±0.06)ng/ml in severe pneumonia group was higher than that(0.06±0.04)ng/ml in mild pneumonia group,the difference was statistically significant,and hs-cTnT level was negatively correlated with SVI,INO,CI(r=-0.435,-0.385,-0.427,all P<0.05).The correlation between CK-MB and HR,FTc,SVV,SVI,CI,INO,SVRI was analyzed,all P>0.05.The levels of WBC,PCT and CRP in severe pneumonia group were not correlated with HR,FTC,SVV,SVI,CI,INO and SVRI respectively,all P>0.05.Conclusion:1.More infants with mild pneumonia could have hemodynamic abnormalities,and most of them were high-output and low-resistance.Most infants with severe pneumonia had different types of hemodynamic abnormalities,and most of them were not high-output and low-resistance,which could turn to normal after treatment.2.Myocardial injury was more serious in severe pneumonia group,the level of Plasma hs-cTnT can be used as an important index to indirectly evaluate the cardiac function.