Perioperative neuroprotective strategies.
Perioperative neuroprotective strategies.
复制标题
DOI：
10.1053/j.pcsu.2008.01.003
复制
发表时间：
2008
期刊：
影响因子：
--
通讯作者：
D. Nelson;D. Andropoulos;C. Fraser
中科院分区：
文献类型：
--
作者：
D. Nelson;D. Andropoulos;C. Fraser
长期神经发育障碍在接受矫正性或姑息性先天性心脏手术的新生儿和婴儿中很常见。这些儿童神经发育障碍的病因是多因素的，包括产前、术前、术中和术后的因素。围手术期的神经监测被认为是预防或挽救不良神经事件不可或缺的一部分。最新的先天性心脏手术灌流技术的进步确保了在体外循环的所有阶段都有足够的脑氧输送。脑室周围白质软化症和其他严重的神经损伤可以通过优化的灌流策略来最小化，包括持续高流量、高红细胞压积体外循环、最少使用深低温停循环、在主动脉弓重建期间顺行脑灌流、pH-稳态血气策略以及NIRS和经颅多普勒脑部监测。因为有证据表明，脑损伤也可以发生在产前、术前和术后，因此迫切需要改进策略来预防这些领域的损伤。有必要进行更广泛的临床研究，以确定手术室和重症监护病房的神经保护管理策略，以保护先天性心脏病儿童的神经功能并优化其长期神经发育结果。
Long-term neurodevelopmental impairment is common in newborns and infants undergoing corrective or palliative congenital heart surgery. The etiologies of neurodevelopmental morbidity in these children are multifactorial and include prenatal, preoperative, intraoperative, and postoperative factors. Perioperative neurologic monitoring is thought to be integral to prevention or rescue from adverse neurologic events. Recent advances in perfusion techniques for congenital heart surgery now ensure adequate cerebral O(2) delivery during all phases of cardiopulmonary bypass. Periventricular leukomalacia and other serious neurologic injury can be minimized by an optimized perfusion strategy of continuous high-flow, high hematocrit cardiopulmonary bypass, minimal use of deep hypothermic circulatory arrest, antegrade cerebral perfusion during aortic arch reconstruction, pH-stat blood gas strategy, and cerebral monitoring with NIRS and trans-cranial Doppler. Because there is evidence that brain injury can also occur in the prenatal, preoperative, and postoperative periods, improved strategies to prevent injury in these arenas are much needed. Extensive further clinical investigation is warranted to identify neuroprotective management strategies for the operating room and intensive care unit to preserve neurologic function and optimize long-term neurodevelopmental outcomes in children with congenital heart disease.