非紫绀型先天性心脏病婴幼儿围体外循环期脑血流动力学变化  

Cerebral hemodynamic changes in infants with non-cyanotic congenital heart disease during extracorporeal circulation and perioperative period

作　　者：钱晶晶[1] 李晓英[1] 俞劲[1] 刘清明 范铭 叶菁菁[1] Qian Jingjing;Li Xiaoying;Yu Jin;Liu Qingming;Fan Ming;Ye Jingjing(Department of Ultrasound,The Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Zhejiang Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院超声科、国家儿童健康与疾病临床医学研究中心,杭州310052

出　　处：《中国体外循环杂志》2021年第4期213-216,共4页Chinese Journal of Extracorporeal Circulation

基　　金：浙江省医药卫生科技项目(2018KY449);浙江省自然科学基金(LY19H150005)。

摘　　要：目的应用经颅彩色多普勒超声(TCCS)观察6月至1岁先天性心脏病(CHD)患儿围体外循环期大脑中动脉(MCA)血流动力学变化。方法对26例正常婴幼儿及22例非紫绀型CHD患儿MCA行经颅超声检查。采用二维及频谱多普勒对比观察正常婴幼儿和CHD患儿MCA术前(T0)、全流量体外循环期(T1)、停体外循环即刻(T2)、术后1 d(T3)和术后7 d(T4)的血流动力学变化。结果22例非紫绀CHD患儿MCA收缩期最大峰值血流速度(PSV)、舒张末期血流速度(EDV)、平均血流速度(Vm)及搏动指数(PI)T0及T4时点与26例正常婴幼儿比较差异均无统计学意义(P>0.05)。T2时PSV和Vm较正常婴幼儿下降,差异有统计学意义(P<0.05)。T3时PI值较正常婴幼儿下降,差异有统计学意义(P<0.05)。结论TCCS能有效监测CHD患儿围术期脑血流动力学变化,通过TCCS证实体外循环手术仅一过性干扰非紫绀CHD患儿脑血流灌注,并未造成永久性的脑损伤。Objective To observe the hemodynamic changes of the middle cerebral artery(MCA)in children with congenital heart disease(CHD)from 6 months to 1 year old during extracorporeal circulation(ECC)and perioperative period by transcranial color Doppler ultrasound(TCCS).Methods TCCS was performed on the MCA of 26 normal infants and 22 children with non-cyanotic CHD to observe cerebral hemodynamic changes before operation(T0),full-flow ECC(T1),immediately after ECC(T2),1 day after operation(T3)and 7 days after operation(T4).Results There was no significant difference(P>0.05)between normal children and children with non-cyanotic CHD preoperatively and 7 days after operation in maximum peak systolic blood flow velocity(PSV),end-diastolic blood flow velocity(EDV),mean blood flow velocity(Vm),and pulsatility index(PI).Compared with normal children,PSV and Vm at T2 and PI at T3 significantly decreased in children with non-cyanotic CHD(P<0.05).Conclusion TCCS can effectively monitor the cerebral hemodynamic changes in children with CHD during ECC and perioperative period.It has been confirmed by TCCS that ECC only temporarily interferes with cerebral blood perfusion in children with non-cyanotic CHD,without causing permanent brain damage.

关 键 词：经颅彩色多普勒超声 脑血流动力学 先天性心脏病 体外循环 围术期 婴幼儿 

分 类 号：R726.5[医药卫生—儿科]