Perioperative stroke in infants undergoing open heart operations for congenital heart disease.
Perioperative stroke in infants undergoing open heart operations for congenital heart disease.
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DOI：
10.1016/j.athoracsur.2009.03.030
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发表时间：
2009-09
影响因子：
4.6
通讯作者：
Ichord, Rebecca
中科院分区：
文献类型：
--
作者：
Chen, Jodi;Zimmerman, Robert A.;Jarvik, Gail P.;Nord, Alex S.;Clancy, Robert R.;Wernovsky, Gil;Montenegro, Lisa M.;Hartman, Diane M.;Nicolson, Susan C.;Spray, Thomas L.;Gaynor, J. William;Ichord, Rebecca
婴儿先天性心脏病手术围手术期卒中的患病率尚未得到很好的描述。本研究的目的是通过术后脑磁共振成像（MRI）评估确定卒中的患病率，描述局灶性缺血性损伤的神经解剖学特征，并确定其发展的风险因素。本文对122例婴幼儿体外循环心脏手术后3~14天行深低温停循环或非深低温停循环的颅脑MRI检查。收集术前、术中和术后数据。危险因素通过logistic回归分析与卒中的单变量和多变量相关性。122例患者中有12例（10%）发生卒中。6例患者在术前发生卒中，其他6例患者可能在术中或术后发生卒中，除1例患者发生临床癫痫发作外，其余患者均无临床症状。动脉闭塞性和分水岭梗死在两个半球的分布相同。多变量分析表明，较低的出生体重、术前插管、术中较低的红细胞压积和术后进入心脏重症监护室时较高的血压是与卒中相关的重要因素。早产、手术时年龄较小、体外循环持续时间和深低温停循环的使用与卒中无显著相关性。接受先天性心脏病手术的婴儿中风的患病率为10%，其中一半发生在术前。大多数在临床上是沉默的，没有神经影像学检测。机制包括血栓栓塞和低灌注，患者特异性、手术特异性和术后风险增加。
The prevalence of perioperative stroke in infants undergoing operations for congenital heart disease has not been well described. The objectives of this study were to determine the prevalence of stroke as assessed by postoperative brain magnetic resonance imaging (MRI), characterize the neuroanatomic features of focal ischemic injury, and identify risk factors for its development. Brain MRI was performed in 122 infants 3 to 14 days after cardiac operation with cardiopulmonary bypass, with or without deep hypothermic circulatory arrest. Preoperative, intraoperative, and postoperative data were collected. Risk factors were tested by logistic regression for univariate and multivariate associations with stroke. Stroke was identified in 12 of 122 patients (10%). Strokes were preoperative in 6 patients and possibly intraoperative or postoperative in the other 6 patients, and were clinically silent except in 1 patient who had clinical seizures. Arterial-occlusive and watershed infarcts were identified with equal distribution in both hemispheres. Multivariate analysis identified lower birth weight, preoperative intubation, lower intraoperative hematocrit, and higher blood pressure at admission to the cardiac intensive care unit postoperatively as significant factors associated with stroke. Prematurity, younger age at operation, duration of cardiopulmonary bypass, and use of deep hypothermic circulatory arrest were not significantly associated with stroke. The prevalence of stroke in infants undergoing operations for congenital heart disease was 10%, half of which occurred preoperatively. Most were clinically silent and undetected without neuroimaging. Mechanisms included thromboembolism and hypoperfusion, with patient-specific, procedure-specific, and postoperative contributions to increased risk.
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DOI：
10.1016/j.jtcvs.2003.09.053
发表时间：
2004-03-01
影响因子：
6
作者：
Galli, KK;Zimmerman, RA;Gaynor, JW
通讯作者：
Gaynor, JW
低体温循环停止或低流量心肺旁路心脏手术后儿童的发育和神经状况
影响因子：
158.5
作者：
BELLINGER, DC;JONAS, RA;NEWBURGER, JW
通讯作者：
NEWBURGER, JW
影响因子：
2
作者：
vanHouten, JP;Rothman, A;Bejar, R
通讯作者：
Bejar, R
影响因子：
9.6
作者：
Bandla, HPR;Hopkins, RL;Gozal, D
通讯作者：
Gozal, D
DOI：
10.1016/s1053-0770(96)80180-7
发表时间：
1996-01-01
影响因子：
2.8
作者：
Jonas, RA
通讯作者：
Jonas, RA