先天性主动脉弓畸形手术中应用脑灌注和停循环方式的神经发育评估  

Neurodevelopmental evaluations in children of congenital aortic arch malformations after surgery with cerebral perfusion and circulatory arrest

作　　者：贺影忠[1] 张蔚[2] 于新迪[2] 王伟[2] 郑景浩[2] He Yingzhong;Zhang Wei;Yu Xindi;Wang Wei;Zheng Jinghao(Department of Internal Neurology,Children's Medical Center,Shanghai Jiao Tong University School of Medicine National Children's Medical Center,Shanghai 200127,China;Department of Cardiothoracic Surgery,Children's Medical Center,Shanghai Jiao Tong University School of Medicine National Children's Medical Center,Shanghai 200127,China)

机构地区：[1]国家儿童医学中心,上海交通大学医学院附属上海儿童医学中心神经内科,上海200127 [2]国家儿童医学中心,上海交通大学医学院附属上海儿童医学中心心胸外科,上海200127

出　　处：《中华小儿外科杂志》2023年第12期1064-1070,共7页Chinese Journal of Pediatric Surgery

摘　　要：目的研究主动脉弓畸形先天性心脏病手术后患儿神经系统发育障碍的发生情况,为先天性心脏病大血管手术中采用选择性脑灌注(selective cerebral perfusion,SCP)方法提供理论依据。方法纳入2019年5月至2021年6月上海儿童医学中心心脏中心患有主动脉弓畸形先天性心脏病(包括主动脉缩窄和主动脉弓中断)进行心脏矫治术的58例患儿临床资料,其中男34例,女24例;手术年龄范围为生后1~2052 d,体重范围为2.5~21.4 kg。纳入患儿按照体外循环灌注方法分为使用SCP(SCP组)和深低温停循环(停循环组)两组,SCP组44例,停循环组14例。对两组患儿的年龄、性别、体重、术中转流时间、主动脉阻断时间、术后血乳酸和降钙素原含量等方面进行总结分析。58例患儿有33例(SCP组22例,停循环组11例)术后1年进行头颅磁共振成像(magnetic resonance imaging,MRI)检查并采用Griffiths心理发育评估量表-中文版(Griffiths development scales-Chinese edition,GDS-C)测评患儿神经发育情况,评分用发育商(development quotient,DQ)表示。两组间DQ评分值比较采用独立样本t检验。结果58例患儿均痊愈出院,临床均无明显神经系统并发症。两组患儿性别、年龄、体重、心肺转流时间、主动脉阻断时间及降钙素原含量等方面的差异均无统计学意义。术后乳酸值SCP组为(2.41±1.08)mmol/l,停循环组为(3.19±1.22)mmol/l,差异有统计学意义(P=0.028);GDS-C神经发育测试手眼协调能区DQ值SCP组和停循环组得分分别为(94.51±14.53)分和(81.95±18.16)分,差异具有统计学意义(P=0.039);运动、个人-社会、听力和语言等能区DQ值SCP组均高于停循环组,虽然差异缺乏统计学意义,但在听力和语言能区两组DQ值≥70分的患儿占比相等,其余能区患儿占比SCP组均高于停循环组。结论SCP是一种简单可行和安全有效的脑保护措施,能提供患儿大脑及部分机体有效的灌注,降低传统婴幼儿�Objective To summarize the outcomes of neurologic development disorders after surgery with selective cerebral perfusion(SCP)in children of aortic arch malformations(including coarctation of aorta&interruption of aortic arch).Methods From May 2019 to June 2021,the relevant clinical data were retrospectively reviewed for 58 children operated for aortic arch malformation.According to whether or not SCP was applied,they were assigned into two groups of SCP(n=22)and circulatory arrest(n=11).Basic profiles of age,gender,weight,clinical manifestations,hospitalization stay,intraoperative bypass duration,aortic occlusion duration,postoperative blood levels of lactate&procalcitonin and postoperative complications were retrospectively reviewed.Thirty-three of them underwent cranial magnetic resonance imaging(MRI).Griffiths mental development assessment score(GDS-C)was assessed at 1 year postoperatively.It was expressed as developmental quotient(DQ).DQ values between two groups were compared by independent t-test.Results There were 34 boys and 24 girls with an age range of(1-2052)day.They were followed up for 1 to 3 years after discharge and weighting from 2.5 to 21.4 kg.Postoperative lactate value was(2.41±1.08)mmol/l and(3.19±1.22)mmol/l in SCP and circulatory arrest groups respectively(P<0.05).GDS-C test results indicated that average DQ scores of hand-eye coordination energy area was(94.51±14.53)and(81.95±18.16)in SCP and circulatory arrest groups respectively(P<0.05).However,scores of DQ in sports,personal-social,hearing and language areas were higher in SCP group than those in circulatory arrest group.The differences were not statistically significant.The percentage of individuals with DQ≥70 in hearing and language areas was equal in two groups.However,percentage ratio in other areas was higher in SCP group than that in circulatory arrest group.Conclusions Mild hypothermia with SCP may be applied with fewer neurological complications.As a feasible,safe and effective cerebral protection measure,SCP provides effect

关 键 词：主动脉缩窄 主动脉弓中断 脑灌注 神经发育障碍 

分 类 号：R726.5[医药卫生—儿科]