Cerebral tissue oxygenation index and lactate at 24 hours postoperative predict survival and neurodevelopmental outcome after neonatal cardiac surgery
Cerebral tissue oxygenation index and lactate at 24 hours postoperative predict survival and neurodevelopmental outcome after neonatal cardiac surgery
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DOI：
10.1111/chd.12426
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发表时间：
2017-03-01
影响因子：
0.3
通讯作者：
Donofrio, Mary T.
中科院分区：
文献类型：
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作者：
Aly, Safwat A.;Zurakowski, David;Donofrio, Mary T.
目前还没有成熟的无创生物标志物来识别先天性心脏病术后预后不良的患者。很少有研究评估近红外光谱（NIRS）测量脑组织氧合指数（cTOI）的预后准确性。目的通过测量cTOI，评估无创NIRS监测在新生儿心脏手术后预后预测中的应用价值。探讨无创NIRS监测结合乳酸浓度和肌力评分对新生儿心脏手术后预后的预测作用。前瞻性纵向队列研究。国家儿童心脏研究所手术室及心脏重症监护病房。75例复杂先天性心脏病患者在出生后第一个月内接受手术修复。术前、术中及术后24小时测量脑TOI、血乳酸和肌力评分。主要观察指标：采用Bayley婴儿发育量表（BSID II）评估术后死亡率和神经发育结局。分别在6、15和21个月时进行精神和运动评分。良好的预后定义为生存和BSID精神和运动评分70分。不良预后定义为死亡或BSID评分
ImportanceThere are no well-established noninvasive biomarkers for identifying patients at risk for poor outcome after surgery for congenital heart disease. Few studies have assessed prognostic accuracy of cerebral tissue oxygenation index (cTOI) measured by near infrared spectroscopy (NIRS).ObjectiveTo assess the utility of noninvasive NIRS monitoring as a predictor of outcomes after neonatal cardiac surgery through measurement of cTOI. To examine the utility of noninvasive NIRS monitoring in combination with lactate concentration and inotropic score in prediction of outcomes after neonatal cardiac surgery.DesignProspective longitudinal cohort study.SettingOperating room and cardiac intensive care unit, Children's National Heart Institute.ParticipantsSeventy-five patients with complex congenital heart disease undergoing surgical repair within first month of life.ExposureCerebral TOI, blood lactate, and inotropic scores were measured preoperative, intraoperative and up to 24 hours postoperative.Main Outcome MeasuresPostoperative mortality and neurodevelopmental outcome assessed by the Bayley Scales of Infant Development (BSID II). Mental and motor scores were obtained at 6, 15, and 21 months. Good outcome was defined as survival and BSID mental and motor scores 70 points. Poor outcome was defined as death or BSID scores