Neurologic sequelae associated with deep hypothermic circulatory arrest
Neurologic sequelae associated with deep hypothermic circulatory arrest
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DOI：
10.1016/s0003-4975(98)00334-8
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发表时间：
1998-06-01
影响因子：
4.6
通讯作者：
Hickey, PR
中科院分区：
文献类型：
--
作者：
Hickey, PR
背景早期关于深低温停循环后神经功能障碍发生率的研究产生了相互矛盾的结果。本文回顾了波士顿循环停搏研究的结果，以及另一项研究的结果，该研究比较了使用alpha-stat和pH-stat策略进行深低温循环停搏后婴儿的神经功能结局。波士顿循环骤停研究的研究人群包括171名3个月以下的婴儿。在围手术期、1年和4年时评价神经系统结局。alpha-stat与pH-stat研究中的研究人群包括182名年龄不超过9个月的婴儿。评估患者术后脑电图（EEG）和临床癫痫发作、首次EEG活动恢复时间、术后死亡率和发病率。循环停止约30分钟后，围手术期临床癫痫发作、EEG癫痫发作的概率增加，EEG活动恢复时间增加。一年的评估显示，循环停止的持续时间与精神发育指数降低和神经系统异常增加有显着关系。四年的评估显示，低现在和循环停搏患者的神经系统检查结果或全面的一般智商没有差异，虽然有循环停搏时间对认知功能的各种分项评分的影响。与pH-stat策略相比，alpha-stat策略往往与更多的EEG发作和更高的术后发病率和死亡率相关，并且与首次EEG活动的恢复时间显著相关。这些研究强烈表明，在接受复杂先天性心脏病心内直视手术的婴儿中，低流量旁路与循环停搏相比具有更好的神经功能结局，并且当使用循环停搏时，pH-stat策略与α-stat策略相比具有更好的结局。(C)1998年，美国胸外科医师协会（Society of Thoracic Surgeons）
Background. Earlier studies of the incidence of neurologic disturbances after deep hypothermic circulatory arrest produced conflicting results. This article reviews the results of the Boston Circulatory Arrest Study, and another study undertaken to compare neurologic outcome in infants after deep hypothermic circulatory arrest using alpha-stat and pH-stat strategies.Methods. The study population in the Boston Circulatory Arrest Study consisted of 171 infants less than 3 months of age. Neurologic outcomes were evaluated perioperatively, at 1 year, and at 4 years. The study population in the alpha-stat versus pH-stat study consisted of 182 infants no older than 9 months of age. Patients were evaluated for postoperative electroencephalographic (EEG) and clinical seizures, recovery time to first EEG activity, and postoperative mortality and morbidity.Results. After about 30 minutes of circulatory arrest there was increasing probability of perioperative clinical seizures, EEG seizures, and increased time to recovery of EEG activity. One-year evaluations showed a significant relation of duration of circulatory arrest to lowered psychomotor developmental index and increased neurologic abnormalities. Four-year evaluations showed no difference between low-now and circulatory-arrest patients in results of neurologic examination or in full-scale general IQ, although there was an effect of circulatory arrest duration on various subscores of cognitive function. Compared with the pH-stat strategy, the alpha-stat strategy tended to be associated with more EEG seizures and higher postoperative morbidity and mortality, and was significantly associated with longer recovery time to first EEG activity.Conclusions. These studies strongly suggest that in infants undergoing open heart operations for complex congenital heart defects, low-now bypass is associated with better neurologic outcome than is circulatory arrest and that the pH-stat strategy is associated with a better outcome than the alpha-stat strategy when circulatory arrest is used. (C) 1998 by The Society of Thoracic Surgeons.