Developmental and neurologic effects of alpha-stat versus pH-stat strategies for deep hypothermic cardiopulmonary bypass in infants
Developmental and neurologic effects of alpha-stat versus pH-stat strategies for deep hypothermic cardiopulmonary bypass in infants
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DOI：
10.1067/mtc.2001.111206
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发表时间：
2001-02-01
影响因子：
6
通讯作者：
Newburger, JW
中科院分区：
文献类型：
--
作者：
Bellinger, DC;Wypij, D;Newburger, JW
目的：在一项随机单中心试验中，我们比较了在深度低温体外循环中使用α -stat与pH-stat策略后，在不到9个月大的儿童接受心脏修复手术后，1岁和2至4岁儿童的发育和神经系统结局。方法：对符合随访条件的168例患儿进行1年发育评价111例，神经学评价110例，脑电图评价102例。122名儿童的父母在孩子2至4岁时完成了行为和发展的问卷调查。结果：α -stat组与pH-stat组精神运动发展指数评分差异无统计学意义（P = 0.97）。在心理发展指数评分方面，治疗组的效果因诊断而异（P = .007）。在大动脉d型转位（n = 59）和法洛四联症（n = 36）亚组中，pH-stat组的智力发展指数得分略高于α -stat组，但差异无统计学意义。在室间隔缺损亚组（n = 16）中，α -stat组得分明显高于对照组。d型大动脉转位组精神运动发展指数和精神发展指数评分显著高于其他两组（P = 0.03和P = 0.01）。在所有诊断中，心理发展指数得分显著高于精神运动发展指数得分（P < 0.001）。治疗组分配与1岁时的神经学检查（P = 0.70）或脑电图检查（P = 0.77）异常或2至4岁时父母对儿童发育（P = 0.99）或行为（P = 0.27）的评分无显著相关性。结论：在深度低温体外循环的修复性婴儿心脏手术中，使用α -stat与pH-stat酸碱管理策略与改善或损害早期神经发育结局并不一致。
Objectives: In a randomized single-center trial, we compared developmental and neurologic outcomes at 1 and 2 to 4 years of age in children who underwent reparative cardiac operations at less than 9 months of age after use of the alpha-stat versus pH-stat strategy during deep hypothermic cardiopulmonary bypass.Methods: Among 168 children eligible for follow-up, 1-year developmental evaluations were carried out on 111, neurologic evaluations on 110, and electroencephalographic evaluations on 102. Parents of 122 children completed questionnaires on behavior and development when children were 2 to 4 years of age.Results: The Psychomotor Development Index scores of the alpha-stat and pH-stat groups did not differ significantly (P = .97). For Mental Development Index scores, the treatment group effect differed according to diagnosis (P = .007). In the D-transposition of the great arteries (n = 59) and tetralogy of Fallot (n = 36) subgroups, the pH-stat group had slightly higher Mental Development Index scores than the alpha-stat group, although these differences were not statistically significant. In the ventricular septal defect subgroup (n = 16), the alpha-stat group had significantly higher scores. Psychomotor Development Index and Mental Development Index scores were significantly higher in the group with D-transposition of the great arteries than in the other 2 groups (P = .03 and P = .01, respectively). Across all diagnoses, Mental Development Index scores were significantly higher than Psychomotor Development Index scores (P < .001). Treatment group assignment was not significantly associated with abnormalities on neurologic examination (P = .70) or electroencephalographic examination (P = .77) at 1 year or with parents' ratings of children's development (P = .99) or behavior (P = .27) at age 2 to 4 years.Conclusions: Use of alpha-stat versus pH-stat acid-base management strategy during reparative infant cardiac operations with deep hypothermic cardiopulmonary bypass was not consistently related to either improved or impaired early neurodevelopmental outcomes.