DEVELOPMENTAL AND NEUROLOGIC STATUS OF CHILDREN AFTER HEART-SURGERY WITH HYPOTHERMIC CIRCULATORY ARREST OR LOW-FLOW CARDIOPULMONARY BYPASS
DEVELOPMENTAL AND NEUROLOGIC STATUS OF CHILDREN AFTER HEART-SURGERY WITH HYPOTHERMIC CIRCULATORY ARREST OR LOW-FLOW CARDIOPULMONARY BYPASS
复制标题
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
DOI：
10.1056/nejm199503023320901
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发表时间：
1995-03-02
影响因子：
158.5
通讯作者：
NEWBURGER, JW
中科院分区：
文献类型：
--
作者：
BELLINGER, DC;JONAS, RA;NEWBURGER, JW
背景。深低温伴全循环停止或低流量心肺转流用于在婴儿心脏手术期间支持重要器官。我们在手术一年后比较了这两种策略的发育和神经系统后遗症。方法。接受动脉转位手术的患有 D 型大动脉转位的婴儿被随机分配至主要包括停循环的支持方法或主要包括低流量旁路的支持方法。一岁时进行发育和神经系统评估以及磁共振成像 (MRI)。结果。在参与该研究的 171 名患者中，有 155 名接受了评估。在对是否存在室间隔缺损进行调整后，与分配到低流量旁路的婴儿相比，分配到循环停止的婴儿在贝利婴儿发育量表的精神运动发展指数上的平均得分较低（6.5分缺陷，P = 0.01），并且得分小于或等于80的比例较高（即低于总体平均值2个标准差或更多）（27％对12％） 百分比，P=0.02）。精神运动发展指数得分与停循环持续时间呈负相关（P=0.02）。神经系统异常的风险随着停循环时间的延长而增加（P=0.04）。支持方法与大脑 MRI 扫描异常的发生率、贝利量表心理发展指数得分或视觉识别记忆测试得分无关。围手术期脑电图癫痫发作活动与精神运动发展指数得分较低 (P=0.002) 以及大脑 MRI 扫描异常的可能性增加相关 (P=0.002)
Background. Deep hypothermia with either total circulatory arrest or low-flow cardiopulmonary bypass is used to support vital organs during heart surgery in infants. We compared the developmental and neurologic sequelae of these two strategies one year after surgery.Methods. Infants with D-transposition of the great arteries who underwent an arterial-switch operation were randomly assigned to a method of support consisting predominantly of circulatory arrest or a method consisting predominantly of low-flow bypass. Developmental and neurologic evaluations and magnetic resonance imaging (MRI) were performed at one year of age.Results. Of the 171 patients enrolled in the study, 155 were evaluated. After adjustment for the presence or absence of a ventricular septal defect, the infants assigned to circulatory arrest, as compared with those assigned to low-flow bypass, had a lower mean score on the Psychomotor Development Index of the Bayley Scales of Infant Development (a 6.5-point deficit, P=0.01) and a higher proportion had scores less than or equal to 80 (i.e., 2 SD or more below the population mean) (27 percent vs. 12 percent, P=0.02). The score on the Psychomotor Development Index was inversely related to the duration of circulatory arrest (P=0.02). The risk of neurologic abnormalities increased with the duration of circulatory arrest (P=0.04). The method of support was not associated with the prevalence of abnormalities on MRI scans of the brain, scores on the Mental Development Index of the Bayley Scale, or scores on a test of visual-recognition memory. Perioperative electroencephalographic seizure activity was associated with lower scores on the Psychomotor Development Index (P=0.002) and an increased likelihood of abnormalities on MRI scans of the brain (P