Preoperative cerebral hemodynamics from birth to surgery in neonates with critical congenital heart disease
Preoperative cerebral hemodynamics from birth to surgery in neonates with critical congenital heart disease
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DOI：
10.1016/j.jtcvs.2018.04.098
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发表时间：
2018-10-01
影响因子：
6
通讯作者：
Licht, Daniel J.
中科院分区：
文献类型：
--
作者：
Lynch, Jennifer M.;Ko, Tiffany;Licht, Daniel J.
背景：缺氧缺血性白色脑损伤常见于新生儿重症先天性心脏病。最近的研究表明，手术时间较长与这种损伤的风险增加有关。在这项研究中，我们调查了从胎儿到新生儿循环过渡期间围产期脑血流动力学的变化，以确定可能导致这种风险的机制。招募患有大动脉转位（TGA）或左心发育不良综合征（HLHS）的新生儿，进行术前无创光学监测脑氧饱和度，脑氧摄取分数，和脑血流量的扩散光谱和扩散相关光谱，2无创光学技术。从知情同意日至手术当天早晨，每天采集测量值。在这些测量参数在术前期间的时间趋势进行了评估与混合效应model.Results：四十八个新生儿TGA或HLHS进行了研究。脑氧饱和度与时间呈显著负相关，氧摄取分数与时间呈显著正相关。术前脑血流量无明显变化。结论：在TGA或HLHS新生儿中，在出生和心脏手术之间的时间段内，增加脑氧摄取加上异常的脑血流反应导致脑组织氧合的进行性降低。结果支持并帮助解释最近研究的生理基础，即手术时间延长会增加风险。白色物质损伤
Background: Hypoxic-ischemic white matter brain injury commonly occurs in neonates with critical congenital heart disease. Recent work has shown that longer time to surgery is associated with increased risk for this injury. In this study we investigated changes in perinatal cerebral hemodynamics during the transition from fetal to neonatal circulation to ascertain mechanisms that might underlie this risk.Methods: Neonates with either transposition of the great arteries (TGA) or hypoplastic left heart syndrome (HLHS) were recruited for preoperative noninvasive optical monitoring of cerebral oxygen saturation, cerebral oxygen extraction fraction, and cerebral blood flow using diffuse optical spectroscopy and diffuse correlation spectroscopy, 2 noninvasive optical techniques. Measurements were acquired daily from day of consent until the morning of surgery. Temporal trends in these measured parameters during the preoperative period were assessed with a mixed effects model.Results: Forty-eight neonates with TGA or HLHS were studied. Cerebral oxygen saturation was significantly and negatively correlated with time, and oxygen extraction fraction was significantly and positively correlated with time. Cerebral blood flow did not significantly change with time during the preoperative period.Conclusions: In neonates with TGA or HLHS, increasing cerebral oxygen extraction combined with an abnormal cerebral blood flow response during the time between birth and heart surgery leads to a progressive decrease in cerebral tissue oxygenation The results support and help explain the physiological basis for recent studies that show longer time to surgery increases the risk of acquiring white matter injury.