Neurodevelopmental outcomes after neonatal cardiac surgery: Role of cortical isoelectric activity.
Neurodevelopmental outcomes after neonatal cardiac surgery: Role of cortical isoelectric activity.
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新生儿心脏手术后的神经发育结果：皮质等电活动的作用。
DOI：
10.1016/j.jtcvs.2015.10.065
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Alfieris,GeorgeM
中科院分区：
文献类型：
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作者：
Seltzer,Laurie;Swartz,MichaelF;Kwon,Jennifer;Burchfiel,James;Cholette,JillM;Wang,Hongyue;Sweeney,Dawn;Adams,HeatherR;Meagher,Cecilia;Angona,Ron;Guillet,Ronnie;Alfieris,GeorgeM
目的患有先天性心脏病的新生儿在心脏手术后面临神经发育受损的风险。我们假设术中脑电图活动可能有助于了解未来的神经发育结果。方法对需要手术的新生儿进行持续的术中脑电图和血流动力学监测。脑电图抑制水平分为：缓慢且持续；中等爆发抑制；严重的爆发抑制；或等电（大脑没有活动超过 3 分钟）。使用 Vineland 适应性行为量表 II (Vineland-II) 评估后续神经发育结果。结果 21 名需要心脏手术的新生儿在全身麻醉后出现缓慢且连续的脑电图模式。 10 名新生儿 (48%) 维持持续的脑电活动，并以中度爆发抑制作为脑电图抑制的最大水平。 11 名新生儿 (52%) 出现严重的爆发抑制，并在停循环所需的深低温期间进入等电状态。然而，这种状态的持续时间明显长于停循环时间（111.1 ± 50 与 22.3 ± 17 分钟；P < .001）。在平均 5.6 ± 1.0 年的随访中，与具有持续脑电活动的新生儿相比，形成等电状态的新生儿在交流方面的 Vineland-II 分数较低。综合 Vineland-II 分数与等电活动持续时间之间存在反比关系 (R = -0.75,P= .01)。在经历等电状态的新生儿中，>90 分钟的持续时间与最低的 Vineland-II 评分相关（125.0 ± 2.6 与 81.1 ± 12.7；P < .01）。结论皮质等电状态的持续时间似乎与神经发育结果相关。在复杂的先天性心脏病手术期间，使用连续脑电图监测来最小化等电状态的策略可能有用。
ObjectivesNeonates with congenital heart disease are at risk for impaired neurodevelopment after cardiac surgery. We hypothesized that intraoperative EEG activity may provide insight into future neurodevelopmental outcomes.MethodsNeonates requiring surgery had continuous intraoperative EEG and hemodynamic monitoring. The level of EEG suppression was classified as either: slow and continuous; moderate burst suppression; severe burst suppression; or isoelectric (no brain activity for >3 minutes). Follow-up neurodevelopmental outcomes were assessed using the Vineland Adaptive Behavior Scale II (Vineland-II).ResultsTwenty-one neonates requiring cardiac surgery developed a slow and continuous EEG pattern after general anesthesia. Ten neonates (48%) maintained continuous brain electrical activity with moderate burst suppression as the maximum level of EEG suppression. Eleven neonates (52%) developed severe burst suppression that progressed into an isoelectric state during the deep hypothermic period required for circulatory arrest. However, the duration of this state was significantly longer than circulatory arrest times (111.1 ± 50 vs 22.3 ± 17 minutes;P< .001). At a mean follow-up at 5.6 ± 1.0 years, compared with neonates with continuous brain electrical activity, neonates who developed an isoelectric state had lower Vineland-II scores in communication. There was an inverse relationship between composite Vineland-II scores and duration of isoelectric activity (R = −0.75,P= .01). Of neonates who experienced an isoelectric state, durations of >90 minutes were associated with the lowest Vineland-II scores (125.0 ± 2.6 vs 81.1 ± 12.7;P< .01).ConclusionsThe duration of cortical isoelectric states seems related to neurodevelopmental outcomes. Strategies using continuous EEG monitoring to minimize isoelectric states may be useful during complex congenital heart surgery.