深低温停循环和顺行脑灌注在新生儿主动脉缩窄矫治术中的应用效果对比  

Application effect of deep hypothermic circulatory arrest versus anterograde cerebralperfusion in neonatal repaired coarctation of aorta: a comparative study

作　　者：黄晶晶[1] 陈家蓉[1] 张赋 农明滩 李纯培 陆燕燕 HUANG Jingjing;CHEN Jiarong;ZHANG Fu;NONG Mingtan;LI Chunpei;LU Yanyan(Department of Pediatric Cardiothoracic Surgery,Maternity and Child Health Care of Guangxi Zhuang Autonomous Region,Nanning 530002,Guangxi,China)

机构地区：[1]广西壮族自治区妇幼保健院儿童心胸外科,广西南宁市530002

出　　处：《广西医学》2023年第23期2825-2830,2841,共7页Guangxi Medical Journal

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z-A20220263)。

摘　　要：目的 比较深低温停循环(DHCA)和顺行脑灌注(ACP)两种灌注方法在新生儿主动脉缩窄矫治术中的有效性和安全性。方法 纳入40例合并有血流动力学异常的心内畸形的主动脉缩窄新生儿作为研究对象,将其随机分为DHCA组(n=20)和ACP组(n=20),分别应用DHCA和ACP技术进行主动脉缩窄矫治术。比较两组患儿围术期(术前、术后第1天、术后第2天)的血清肌酐水平,以及术后急性肾损伤(AKI)和其他术后并发症的发生情况,对比两组的停循环或者脑灌注时间、主动脉阻断时间、体外循环持续时间、停循环期或脑灌注期间脑组织和肾脏组织血氧饱和度、术后AKI少尿期放置腹膜透析时间、术后呼吸机使用时间、心脏ICU(CICU)停留时间及总住院时间。结果 术后住院期间复查超声心动图提示40例患儿心内畸形矫治满意,且无死亡病例。两组患儿血清肌酐水平有随时间延长而升高的趋势,而ACP组术后第1天及第2天的血肌酐水平低于DHCA组(P<0.05)。所有患儿术后均出现AKI,但未发生神经系统损伤和不可逆性肾功能衰竭,两组其他术后并发症总发生率差异无统计学意义(P>0.05)。两组停循环或者脑灌注时间差异无统计学意义(P>0.05),而ACP组脑组织及肾脏组织血氧饱和度优于DHCA组,主动脉阻断时间、体外循环总时间、呼吸机使用时间、CICU停留时间、术后AKI少尿期放置腹膜透析时间及总住院时间短于DHCA组(P<0.05)。结论 对于合并有血流动力学异常的心内畸形的主动脉缩窄新生儿,相对于DHCA,ACP应用于主动脉缩窄矫治术可发挥更优的脑部和肾脏保护作用,可能更加安全、有效。Objective To compare the effectiveness and safety between two perfusion methods of deep hypothermic circulatory arrest(DHCA)and anterograde cerebral perfusion(ACP)in neonatal repaired coarctation of aorta.Methods A total of 40 neonates with coarctation of aorta of intracardiac malformation and concomitant hemodynamic abnormality were enrolled as the research subjects,and they were randomly assigned to DHCA group(n=20)or ACP group(n=20).DHCA and ACP techniques were applied to perform repaired coarctation of aorta,respectively.The level of serum creatinine during perioperative period(before operation,on the first day after operation,on the second day after operation),and postoperative acute kidney injury(AKI),the occurrence of other postoperative complications were compared between patients of the two groups.Time to circulatory arrest or cerebral perfusion,aortic cross clamp time,cardiopulmonary bypass duration,oxyhemoglobin saturation in brain and renal tissues during circulatory arrest period or cerebral perfusion period,postoperative AKI duration of peritoneal dialysis placement during oliguria period,postoperative ventilatory use time,length of cardiac ICU(CICU)stay,and total length of hospital stay were compared between patients of the two groups.Results Echocardiography during postoperative hospitalization indicated that 40 children with intracardiac malformation were successfully repaired,and no death occurred.Serum creatinine level of the two groups tended to elevate with time prolonging,and serum creatinine level of the ACP group was lower than that of the DHCA group on the first and second days after operation(P<0.05).All children suffered from AKI after operation,but no nervous system injury and irreversible renal failure occurred.There was no statistically significant difference in the total incidence rate of other postoperative complications between the two groups(P>0.05).There was no statistically significant difference in time to circulatory arrest or cerebral perfusion between the two groups(P>0.05)

关 键 词：主动脉缩窄 心内畸形 深低温停循环 顺行脑灌注 矫治术 灌注策略 脑保护作用 急性肾损伤 新生儿 

分 类 号：R722.1[医药卫生—儿科]