Attentional dysfunction in children after corrective cardiac surgery in infancy
Attentional dysfunction in children after corrective cardiac surgery in infancy
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DOI：
10.1016/j.athoracsur.2006.10.069
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发表时间：
2007-04-01
影响因子：
4.6
通讯作者：
Seghaye, Marie-Christine
中科院分区：
文献类型：
--
作者：
Hoevels-Guerich, Hedwig H.;Konrad, Kerstin;Seghaye, Marie-Christine
背景婴儿期心脏矫正手术后儿童的注意力功能障碍很少被评估，这是目前工作的主题。40例先天性心脏病患儿，20例法洛四联症伴低氧血症，20例室间隔缺损伴心功能不全，平均年龄0.7岁深低温停循环和低流量体外循环（SD 0.3）年，平均年龄7.4岁（SD 1.6）年的计算机化形式的注意力网络测试提供的性能措施的三个网络的注意：警觉，定向，和执行控制。注意力障碍的父母评级来自儿童行为检查表。将结果与健康对照组进行比较，并与围手术期危险因素和当前神经发育状态进行相关性分析。法洛四联症组的执行控制能力降低，警觉和定向能力正常，两组患者之间没有差异。主动脉阻断的持续时间与定向呈负相关;心肺转流的持续时间与平均反应时间呈负相关，与执行控制呈负相关。运动功能和获得能力与执行控制和定向相关。父母报告的问题，儿童行为检查表与执行控制和平均准确性呈负相关。与正常儿童和无紫绀型心脏缺陷的儿童相比，因紫绀型心脏缺陷而在婴儿期发生术前低氧血症的儿童在执行控制领域发生注意力功能障碍的风险增加。除了不利的围手术期影响，术前低氧血症被认为是负责额外的损害，高氧敏感区的前额叶皮层和纹状体假设与执行控制网络的注意。
Background. Attentional dysfunction in children after corrective cardiac surgery in infancy has rarely been evaluated and is the topic of the present work.Methods. Forty unselected children, 20 with tetralogy of Fallot and hypoxemia and 20 with ventricular septal defect and cardiac insufficiency, operated on at a mean age 0.7 (SD 0.3) years with deep hypothermic circulatory arrest and low flow cardiopulmonary bypass, were evaluated at mean age 7.4 (SD 1.6) years by the computerized form of the Attention Network Test providing performance measures of three networks of attention: alerting, orienting, and executive control. Parental ratings of attentional dysfunction were derived from the Child Behavior Checklist. Results were compared with healthy controls, between patient groups, and correlated with perioperative risk factors and current neurodevelopmental status.Results. Executive control was reduced in the tetralogy of Fallot group, alerting and orienting were found normal and not different between patient groups. Durations of aortic cross clamping inversely correlated with orienting; durations of cardiopulmonary bypass correlated with mean reaction time and inversely correlated with executive control. Motor function and acquired abilities correlated with executive control and orienting. Parent-reported problems on the Child Behavior Checklist inversely correlated with executive control and mean accuracy.Conclusions. Children with preoperative hypoxemia in infancy due to cyanotic cardiac defects are at increased risk for attentional dysfunction in the field of executive control, compared with normal children and with those who have acyanotic heart defects. Besides unfavorable perioperative influences, preoperative hypoxemia is considered responsible for additional damage to the highly oxygen sensitive regions of the prefrontal cortex and striate body assumed to be associated with the executive control network of attention.