接受体外循环的先心病患儿认知功能的动态研究  

The Dynamic Research on Cognitive Functioning in Children with Congenital Heart Disease Following Cardiac Surgery with Cardiopulmonary Bypass

作　　者：范祥翠[1] 李大珍[1] 石远[1] 徐颖[1] 叶茂[1] 

机构地区：[1]重庆医科大学附属儿童医院麻醉科,重庆400014

出　　处：《中国心理卫生杂志》2008年第11期824-828,共5页Chinese Mental Health Journal

基　　金：重庆市卫生局基金(04-2-035)

摘　　要：目的:研究0～4岁行体外循环(Cardiopulmonary bypass,CPB)心脏直视手术的先天性心脏病(Congenital heart disease,CHD)患儿,在术前、术后1周、术后1月神经认知功能的情况。方法:对110例0～4岁CPB下行心脏直视手术的患儿(紫绀型36例,非紫绀型74例),在术前、术后1周、1月用Ge- sell发展量表进行神经认知功能测评。结果:患儿术前神经认知功能处于中下水平,紫绀型患儿的应物能、应人能、运动能、语言能得分均低于非紫绀型患儿[(81.5±7.0)vs.(87.7±7.3)、(80.7±6.8)vs.(87.7±8.1)、(79.2±6.4)vs.(87.2±8.7)、(80.8±6.1)vs.(87.4±8.6),P<0.001或0.01];4个方面得分术后1周均低于术前[如应人能:(82.8±7.7)vs.(85.4±8.3),P=0.002],术后1月均高于术前[如应人能:(91.3±6.2)vs.(85.4±8.3),P=0.001];年龄与应物能、应人能、运动能、语言能均呈负相关(如术后1周年龄与非紫绀型应人能β=-3.7,与紫绀型应人能β=-0.6);非紫绀型组的ICU停留时间与术后1周应人能、运动及术后1月应人能呈负相关(β=-0.6、-0.4、-0.4);非紫绀型组与紫绀型组的最低鼻咽温与术后1周语言能呈正相关(β-1.7、2.7);紫绀型组主动脉阻断时间与术后1周认知能力的4个方面及术后1月应物、应人呈负相关(β=-9.6、-3.9、-3.4、-4.7、-3.9、-7.8)。结论:接受手术时的年龄越大认知功能水平越低;在短期内,ICU停留时间、最低鼻咽温、主动脉阻断时间对患儿的认知功能有影响,且对紫绀型患儿的影响大于非紫绀型患儿。Objective： To evaluate dynamic changes in cognitive functioning of children aged 0 -4 years with serious congenital heart disease （CHD） following cardiac surgery with cardiopulmonary bypass （CPB） at postoperative 1 week and 1 month. Methods： One hundred and ten children with cyanotic or acyanotic congenital heart disease, aged 0 -4 years, who received cardiac surgery with CPB were evaluated with neuropsychological and behavioral meth- ods. The evaluation was performed by using the Gesell developmental schedules （ GDS ） preoperatively and at 1 week and 1 month postoperatively. Results： The motor function, language, intelligence and acquired abilities of cyanotic group were lower than those of acyanotic group [（81.5±7.0） vs. （87.7±7.3）, （80.7±6.8） vs. （87.7±8.1）, （79.2±6.4） vs. （87.2±8.7）, （80.8±6.1） vs. （87.4±8.6）; P〈0.001 or 0.01], the above indexes of postoperative one week were lower than preoperative indexes [ such as acquired abilities ： （82.8±7.7） vs. （85.4±8.3）, P =0.002 ], the index of postoperative one month was obviously better than preoperative index [such as acquired abilities：（91.3±6.2） vs. （85.4±8.3）, P =0. 001 ] . The motor function, language, intelligence and acquired abilities were negatively correlated with age （such as the correlation between age and acquired abilities at postoperative 1 week, in acyanotic group, β= - 3.7, and in cyanotic group, β= - 0. 6）. Longer postoperative stay in ICU （cardiac intensive care unit） was negatively correlated with worse acquired abilities, motor function at postop-erative one week in the acyanotic group and acquired abilities at postoperative one month （β=- 0. 6, -0.4, - 0.4 respectively） . The minim nose-throat temperature was positively correlated with language at postoperative one week （β= ＋1. 7, ＋2. 7 respectively）. The time of aorta circulatory arrest was negatively correlated with the reduction in four fields of cognitive functioning at postoperati

关 键 词：体外循环 认知功能测试 先天性心脏病患儿 术后短期影响 纵向调查 

分 类 号：R654.1[医药卫生—外科学] B842.1[医药卫生—临床医学]