Periventricular leukomalacia is common after neonatal cardiac surgery
Periventricular leukomalacia is common after neonatal cardiac surgery
复制标题
DOI：
10.1016/j.jtcvs.2003.09.053
复制
发表时间：
2004-03-01
影响因子：
6
通讯作者：
Gaynor, JW
中科院分区：
文献类型：
--
作者：
Galli, KK;Zimmerman, RA;Gaynor, JW
目的：脑室周围白质软化症是由于未成熟的少突胶质细胞损伤而引起的邻近侧脑室的大脑白色物质的坏死。在没有先天性心脏病的婴儿中，脑室周围白质软化症与发育迟缓和注意力缺陷/多动障碍的发生率增加有关。脑室周围白质软化症的发病率和婴儿心脏手术后脑室周围白质软化症的危险因素尚不清楚。方法：对105名年龄小于或等于6个月的新生儿和婴儿在心脏手术后6 ~ 14天进行了脑磁共振成像，采用心肺转流伴或不伴深低温停循环。结果：手术时的中位年龄为6天（范围1-178），82例新生儿（年龄小于或等于30天）。44例新生儿（54%）发现脑室周围白质软化，而23例婴儿中有1例（4%）。使用手术时年龄作为连续变量的正向logistic回归确定了一个模型，该模型包含较长的总支持时间（心肺转流加深低温停循环），术后心脏重症监护室入院时较低的收缩压，术后前48小时较低的最低舒张压和Po-2。当手术时的年龄被认为是一个二分变量（新生儿与婴儿）时，手术时的年轻年龄取代了模型中的收缩压、Po-2和总支持时间。较低的最低舒张压是一个显着的危险因素，在这两个models.Conclusions：脑室周围白质软化被发现在> 50%的新生儿心脏手术后，但很少在年龄较大的婴儿。术后早期低氧血症和低血压，特别是舒张期低血压，可能是脑室周围白质软化的重要危险因素。
Objectives: Periventricular leukomalacia is necrosis of the cerebral white matter adjacent to the lateral ventricles and results from injury to immature oligodendroglia. In infants without congenital heart disease, periventricular leukomalacia is associated with an increased incidence of developmental delay and attention deficit/ hyperactivity disorder. The incidence of periventricular leukomalacia and the risk factors for development of periventricular leukomalacia after infant cardiac surgery are not known.Methods: Magnetic resonance imaging of the brain was performed 6 to 14 days after cardiac surgery utilizing cardiopulmonary bypass with or without deep hypothermic circulatory arrest in 105 neonates and infants less than or equal to 6 months of age.Results: Median age at surgery was 6 days (range 1-178), with 82 neonates (age less than or equal to 30 days). Periventricular leukomalacia was found in 44 of the neonates (54%) compared with 1 of 23 infants (4%). Forward logistic regression using age at surgery as a continuous variable identified a model containing longer total support time (cardiopulmonary bypass plus deep hypothermic circulatory arrest), lower systolic blood pressure at cardiac intensive care unit admission postoperatively, lower minimum diastolic blood pressure, and Po-2 in the first 48 hours after surgery. When age at surgery was considered as a dichotomous variable (neonate versus infant), younger age at surgery replaced systolic blood pressure, Po-2, and total support time in the model. Lower minimum diastolic blood pressure was a significant risk factor in both models.Conclusions: Periventricular leukomalacia was found in > 50% of neonates after cardiac surgery but rarely in older infants. Hypoxemia and hypotension in the early postoperative period, particularly diastolic hypotension, may be important risk factors for periventricular leukomalacia.