Hypothermia, circulatory arrest, and the pediatric brain
Hypothermia, circulatory arrest, and the pediatric brain
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DOI：
10.1016/s1053-0770(96)80180-7
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发表时间：
1996-01-01
影响因子：
2.8
通讯作者：
Jonas, RA
中科院分区：
文献类型：
--
作者：
Jonas, RA
对波士顿一家儿童医院正在进行的低温停循环（HCA）和低流量体外循环（LFB）的临床和实验室研究进行了审查。 HCA 与 LFB 的一项前瞻性随机临床试验显示，随机接受 HCA 的患者围手术期癫痫发作的发生率较高。一岁时，神经学和发育研究表明癫痫发作与较差的结局之间存在关联。 HCA 持续时间越长，贝利量表评估的粗大和精细运动功能得分越差，并且神经系统异常的可能性越高。对 Senning 程序 HCA 后发育的回顾性审查显示，HCA 前冷却期间的碱性 pH 值（α 统计策略）与相对于酸性策略（pH 统计）较低的发育评分之间存在相关性。阿尔法统计的制度改变伴随着 HCA 后的几例舞蹈手足徐动症。目前，患者被随机分配接受α-stat 和pH stat。实验室研究使用仔猪模型来评估脑血流量和代谢，以及通过磁共振波谱法测定高能磷酸盐和脑 pH 值。高能磷酸盐以 50 mL/kg/min 的流速维持，但在 HCS 约 35 分钟后检测不到。与 α-stat 相比，pH-stat 与 HCA 后高能磷酸盐的更快恢复相关。最近的研究探讨了一氧化氮在 HCA 后脑损伤中的作用，以及脑麻痹在增加停循环安全持续时间方面的潜在效用。版权所有 (C) 1996 W.B.桑德斯公司。
A review has been conducted of ongoing clinical and laboratory studies of hypothermic circulatory arrest (HCA) and low-flow cardiopulmonary bypass (LFB) at a children's hospital in Boston. A prospective randomized clinical trial of HCA versus LFB has shown a higher incidence of perioperative seizures in patients randomized to HCA. At 1 year of age, neurologic and developmental studies have shown an association between seizures and worse outcome. Longer duration of HCA is associated with a worse score on the Bayley scale assessment of gross and fine motor function in particular, as well as a higher probability of neurologic abnormality. A retrospective review of development after HCA for Senning procedure has shown a correlation between more alkaline pH (alpha-stat strategy) during cooling before HCA and lower developmental score relative to a more acidotic strategy (pH stat). The institutional change to alpha stat was accompanied by several cases of choreoathetosis after HCA. Currently, patients are being randomized between alpha-stat and pH stat. Laboratory studies have used a piglet model with assessment of cerebral blood flow and metabolism as well as high-energy phosphates and cerebral pH determined by magnetic resonance spectroscopy. High-energy phosphates are maintained by a flow rate of 50 mL/kg/min but are undetectable after approximately 35 minutes of HCS. A pH-stat is associated with more rapid recovery of high-energy phosphates after HCA than alpha-stat. Recent studies have examined the role of nitric oxide in the causation of brain injury after HCA as well as the potential utility of cerebroplegia in increasing the safe duration of circulatory arrest. Copyright (C) 1996 by W.B. Saunders Company.