【摘要】 目的 评估小婴儿室间隔缺损（ventricular septal defect,VSD）修补术后左心室肌力指数（Smith-Madigan inotropy index,SMII）和外周血管阻力指数（systemic vascular resistance index,SVRI）的变化特点，为出院后患儿的随访治疗提供依据。方法 选取2011年10月至2013年7月在广东省人民医院儿童重症监护室（PICU）和新生儿重症监护室（NICU）住院已成功接受VSD修补术的VSD小婴儿36例。所有研究对象在术后7～10 d、术后3个月、术后6个月分别使用超声心排血量监测仪（ultrasonic cardiac output monitor,USCOM）行血流动力学检查。采用SPSS软件方差分析和Bonferroni法分析术后左心室SMII和SVRI的变化特点。结果 VSD修补术后小婴儿36例，男24例，女12例；月龄3（1～5）个月，体质量（4.32±0.87）kg。术后3个月随访率为89%（32/36），术后6个月随访率为81%（29/36）。VSD婴儿的左心室SMII在术后3个月较术后7～10 d明显下降，差异有统计学意义[（1.2±0.2）W·m^-2vs.（1.4±0.5）W·m^-2,P<0.05]；术后6个月与术后3个月比较，差异无统计学意义[（1.1±0.2）W·m^-2vs.（1.2±0.2）W·m^-2,P>0.05]。SVRI在术后3个月较术后7～10 d有下降趋势，但差异无统计学意义[（973±1431）ds·cm^-5·m²vs.（1 055±268）ds·cm^-5·m²,P=0.072]；术后6个月较术后3个月升高，差异有统计学意义[（1 101±122）ds·cm^-5·m²vs.（973±1431）ds·cm^-5·m²,P<0.01]。结论 小婴儿VSD修补术后3个月内，左心室SMII、SVRI分别从术后早期的偏高水平，呈现不同程度的下降过程；继续随访至术后6个月，左心室SMII维持不变，SVRI出现生理性升高。使用USCOM实时快速随访VSD修补术后小婴儿的心血管功能，为术后用药提供准确个体化指导，对提高临床预后意义重大。更多还原

【Abstract】 Objectives To evaluate the changes of left ventricular Smith-Madigan inotropy index（SMII）and systemic vascular resistance index（SVRI）after surgical repair of ventricular septal defect（VSD）in infants,in order to guide post-operative follow-up after discharge.Methods 7-10 days after VSD repair were enrolled. SMII,SVRI and other parameters were measured at 7-10 day,and at 3 and6 months after operation using ultrasonic cardiac output monitor（USCOM）. Hemodynamic parameters were assessed and compared during the 6-month follow-up. Analysis of variance and Bonferroni method of SPSS were performed.Results Thirty-six subjects[38 male and 17 female,aging 3（1-5）months and weighing（4.32 ± 0.87）kg]were enrolled. Followup rate at 3 months was 89%（32/36）,and 81%（29/36）at 6 months. During follow-up,left ventricular SMII decreased at 3 months postoperatively[（1.2±0.2）W·m^-2vs.（1.4±0.5）W·m^-2,P<0.05]and then tended to be stable at 6 months[（1.1±0.2）W·m^-2vs.（1.2±0.2）W·m^-2,P>0.05]. SVRI tended to decline at 3 months[（973±1431）ds·cm^-5·m²vs.（1 055±268）ds·cm^-5·m²,P=0.072],but increased at 6 months[（1 101±122）ds·cm^-5·m²vs.（973±1431）ds·cm^-5·m²,P<0.01].Conclusions In VSD infants after surgical repair,SMII and SVRI show a decline from a relatively high level to normal about 3 months postoperatively,then SMII keeps stable and SVRI increases as a physiological change at 6months postoperatively. USCOM may be a promising way to monitor the cardiovascular function in VSD infants after surgery,guiding individualized and rationalized medication during follow-up.更多还原