Cardiac dysfunction following brain death after severe pediatric traumatic brain injury: A preliminary study of 32 children.
Cardiac dysfunction following brain death after severe pediatric traumatic brain injury: A preliminary study of 32 children.
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DOI：
10.4103/2229-5151.158409
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发表时间：
2015-04
影响因子：
--
通讯作者：
Vavilala MS
中科院分区：
文献类型：
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作者：
Krishnamoorthy V;Prathep S;Sharma D;Fujita Y;Armstead W;Vavilala MS
脑死亡后的心功能障碍已经在各种脑损伤范例中得到了描述，但在严重的儿童创伤性脑损伤(TBI)后还没有被很好地理解。心脏功能不全可能对这一患者群体的器官捐赠有影响。我们对2003-2011年间重型颅脑损伤后2周内接受超声心动图检查的有脑死亡和无脑死亡的儿童患者进行了一项回顾性队列研究。我们检查了有和没有脑死亡诊断的患者的心功能障碍。总共有1,413名儿童重型颅脑损伤患者中的32名(2.3%)接受了超声心动图评估。颅脑短缩伤评分多为5分(2~6分)，硬膜下血肿占34.4%。10例重型颅脑损伤患者发生脑死亡，而22例重型颅脑损伤患者没有脑死亡。10例脑死亡患儿中4例(40%)射血分数(EF)降低，而22例无脑死亡的患儿EF降低1例(4.5%)(OR=14，P=0.024)。与无脑死亡的儿童重型颅脑损伤患者相比，诊断为脑死亡的儿童重型颅脑损伤患者心功能障碍的发生率更高。这一发现可能会对这一人群的心脏器官捐赠产生影响，值得进一步研究。
Cardiac dysfunction after brain death has been described in a variety of brain injury paradigms but is not well understood after severe pediatric traumatic brain injury (TBI). Cardiac dysfunction may have implications for organ donation in this patient population. We conducted a retrospective cohort study of pediatric patients with severe TBI, both with and without a diagnosis of brain death, who underwent echocardiography during the first 2 weeks after TBI, between the period of 2003–2011. We examined cardiac dysfunction in patients with and without a diagnosis of brain death. In all, 32 (2.3%) of 1,413 severe pediatric TBI patients underwent echocardiogram evaluation. Most patients had head abbreviated injury score 5 (range 2–6) and subdural hematoma (34.4%). Ten patients with TBI had brain death compared with 22 severe TBI patients who did not have brain death. Four (40%) of 10 pediatric TBI patients with brain death had a low ejection fraction (EF) compared with 1 (4.5%) of 22 pediatric TBI patients without brain death who had low EF (OR = 14, P = 0.024). The incidence of cardiac dysfunction is higher among pediatric severe TBI patients with a diagnosis of brain death, as compared to patients without brain death. This finding may have implications for cardiac organ donation from this population and deserves further study.