先天性心脏病术后近期严重神经系统异常的相关因素分析  

Related factors for postoperative neurologic abnormalities immediately after surgery with cardiopulmonary bypass for congenital heart disease

作　　者：洪岚岚 范佳杰[1] 邱芸香[1] 刘明南 张倩男 施珊珊[1] Hong Lanlan;Fan Jiajie;Qiu Yunxiang;Liu Mingnan;Zhang Qiannan;Shi Shanshan(Cardiac Intensive Care Unit,National Clinical Medical Research Center of Pediatric Health and Diseases,Affiliated Children's Hospital,Zhejiang University School of Medicine,National Children's Regional Treatment Center,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院心脏重症监护室,国家儿童健康与疾病临床医学研究中心,国家儿童区域治疗中心,杭州310052

出　　处：《临床小儿外科杂志》2024年第1期51-55,共5页Journal of Clinical Pediatric Surgery

基　　金：浙江省基础公益研究计划(LGF21H02004)

摘　　要：目的总结先天性心脏病(简称先心病)体外循环术后近期(1个月内)发生神经系统异常患儿的临床特征,分析术后近期发生严重神经系统异常的高危因素。方法回顾性分析2016年2月至2020年4月浙江大学医学院附属儿童医院心脏重症监护室(cardiac intensive care unit,CICU)收治的73例因先心病行体外循环下心脏手术,术后1个月内发生神经系统异常患儿的临床资料。根据是否需要接受抗癫痫治疗、外科手术干预及高压氧康复治疗将患儿分为严重神经系统异常组(n=15)和非严重神经系统异常组(n=58),对比两组患儿先心病类型、年龄、体重、体外循环时间、主动脉阻断时间、CICU滞留时间、住院时间、是否存在撤机后再插管以及围手术期心肺复苏(cardiopulmonary resuscitation,CPR)史等资料,采用单因素分析和二元Logistic回归分析先心病患儿手术后近斯发生严重神经系统异常的影响因素。结果经单因素分析发现,体外循环时间和主动脉阻断时间长、应用体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)、合并气道狭窄、术后撤机后再插管、有围手术期心肺复苏史及非计划再次心血管手术是术后发生严重神经系统异常的相关因素(P<0.05)。Logistic回归分析结果提示:体外循环时间延长(OR=1.014,95%CI:1.002~1.025)和主动脉阻断时间延长(OR=1.030,95%CI:1.001~1.059)、撤机后再次插管(OR=0.157,95%CI:0.037~0.669)是术后发生严重神经系统异常的独立危险因素。结论先心病体外循环心内直视手术后实施程序化神经系统功能监测和评估有利于早期发现神经功能异常,临床上应避免长时间的体外循环、主动脉阻断及撤机后再次插管,以减少严重神经系统异常并发症的发生。Objective To summarize the clinical characteristics of children with postoperative neurologic abnormalities immediately after surgery with cardiopulmonary bypass(CPB)for congenital heart disease(CHD)and explore the risk factors of postoperative severe neurologic abnormalities within 1 month after surgery.Methods From February 2016 to April 2020,retrospective analysis was performed for the clinical data of 73 children with neurologic abnormalities within 1 month after cardiac surgery with CPB.They were divided into two groups of severe and non-severe neurological abnormality.Risk factors included type of CHD,age,weight,CPB time,aortic cross-clamp time,cardiac intensive care unit(CICU)retention time and hospitalization stay were compared between two groups by SPSS 25.0 for statistical processing.Results Among them,15 cases developed severe neurological abnormalities.Logistic multivariate analyses indicated that prolonged CPB time(OR=1.014,95%CI:1.002-1.025),prolonged aortic cross-clamp time(OR=1.030,95%CI:1.001-1.059)and reintubation after weaning(OR=0.157,95%CI:0.037-0.669)were independent risk factors for severe neurological abnormalities.Conclusions Programmed nervous system monitoring and evaluation are essential for early recognizing neurologic abnormalities after cardiac surgery with CPB.Longer CPB time,aortic occlusion time and necessity for re-intubation are the independent risk factors for severe neurologic abnormalities immediately after surgery.

关 键 词：先天性心脏病 体外循环 神经系统异常 外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]