Sharma R, Choudhary S K, Mohan M R, Padma M V, Jain S, Bhardwaj M, Bhan A, Kiran U, Saxena N, Venugopal P
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
Ann Thorac Surg. 2000 Aug;70(2):575-81. doi: 10.1016/s0003-4975(00)01397-7.
The immediate and intermediate-term neurodevelopmental outcome in infants undergoing open heart procedures using deep hypothermic cardiopulmonary bypass was assessed prospectively.
One hundred consecutive infants (age 2 to 174 days) were operated on using either deep hypothermic bypass only (group A, n = 28), or with associated circulatory arrest (group B, n = 72). Early neurological outcome was recorded. Survivors underwent mental development evaluation after 31 to 55 months. Fifty other children of similar demographic profile but without heart disease were also tested as controls.
In group A, there were two neurological deaths. In group B, 5 patients had clinical seizures, 1 had monoparesis and 1 had hyperkinetic syndrome with decreased attention span. Mean mental performance quotient was 90.0+/-8.2 in group A, and 89.1+/-6.8 in group B, (group A vs. B, p = 0.60). Mean mental performance quotient in the control group was 101.4+/-8.4, which was significantly higher than the patient population (p << 0.001). No correlation was found between duration of circulatory arrest and postoperative mental performance quotient.
There was significant retardation of mental development in infants operated with deep hypothermic cardiopulmonary bypass. However, use of total circulatory arrest and its duration did not affect clinical outcome up to preschool age.
对采用深低温体外循环进行心脏直视手术的婴儿的近期和中期神经发育结局进行了前瞻性评估。
连续100例婴儿（年龄2至174天）接受手术，其中仅采用深低温体外循环（A组，n = 28），或联合循环停止（B组，n = 72）。记录早期神经学结局。幸存者在31至55个月后接受智力发育评估。另外选取50名人口统计学特征相似但无心脏病的儿童作为对照进行测试。
A组有2例神经学死亡。B组有5例出现临床癫痫发作，1例出现单瘫，1例出现注意力不集中的多动综合征。A组平均智力商数为90.0±8.2，B组为89.1±6.8（A组与B组比较，p = 0.60）。对照组平均智力商数为101.4±8.4，显著高于患者群体（p << 0.001）。未发现循环停止时间与术后智力商数之间存在相关性。
采用深低温体外循环进行手术的婴儿存在明显的智力发育迟缓。然而，在学龄前，全循环停止的使用及其持续时间并未影响临床结局。
