de Ferranti Sarah, Gauvreau Kimberlee, Hickey Paul R, Jonas Richard A, Wypij David, du Plessis Adre, Bellinger David C, Kuban Karl, Newburger Jane W, Laussen Peter C
Children's Hospital, Boston, Massachusetts 02115, USA.
Anesthesiology. 2004 Jun;100(6):1345-52. doi: 10.1097/00000542-200406000-00005.
It is unknown whether intraoperative hyperglycemia in infants is associated with worse neurodevelopmental outcomes after low-flow cardiopulmonary bypass (LF), deep hypothermic circulatory arrest (CA), or both.
In a database review of a prospective trial of 171 infants undergoing arterial switch for D-transposition of the great arteries who were randomly assigned to predominantly LF or CA, glucose was measured after induction (T1), 5 min after cardiopulmonary bypass onset (T2), at the onset of CA or LF (T3), 5 min after CPB resumption (T4), at rewarming to 32 degrees C (T5), 10 min after cardiopulmonary bypass weaning (T6), and 90 min after CA or LF (T7). Outcomes included seizures, electroencephalographic findings, and neurodevelopmental evaluation at 1, 4, and 8 yr.
Glucose concentrations were affected by support strategy and age at surgery. Lower glucose in the entire group at T6-T7 tended to predict electroencephalographic seizures (P = 0.06 and P = 0.007) but was not related to clinical seizures. Within the predominantly CA group, higher glucose did not correlate with worse outcomes. Rather, it was associated with more rapid electroencephalographic normalization of "close burst" and "relative continuous" activity at all times except T2 (P < or = 0.03), a finding more pronounced in infants aged 7 days old or younger. Intraoperative serum glucose concentrations were unrelated to neurodevelopmental outcomes at ages 1, 4, and 8 yr.
Low glucose after cardiopulmonary bypass tended to relate to electroencephalographic seizures and slower electroencephalogram recovery, independent of CA duration. High glucose concentrations were not associated with worse neurodevelopmental outcomes. Avoiding hypoglycemia may be preferable to restricting glucose in infants undergoing heart surgery.
目前尚不清楚婴儿术中高血糖是否与低流量心肺转流（LF）、深低温停循环（CA）或两者兼有的情况下更差的神经发育结局相关。
在一项对171例因大动脉转位接受动脉调转术的婴儿进行的前瞻性试验的数据库回顾中，这些婴儿被随机分配至主要采用LF或CA的治疗组，于诱导后（T1）、心肺转流开始后5分钟（T2）、CA或LF开始时（T3）、心肺转流恢复后5分钟（T4）、复温至32摄氏度时（T5）、心肺转流停止后10分钟（T6）以及CA或LF后90分钟（T7）测量血糖。结局指标包括癫痫发作、脑电图结果以及1年、4年和8年时的神经发育评估。
血糖浓度受支持策略和手术时年龄的影响。在T6 - T7时全组较低的血糖倾向于预测脑电图癫痫发作（P = 0.06和P = 0.007），但与临床癫痫发作无关。在主要采用CA的治疗组中，较高的血糖与更差的结局无关。相反，除T2外，它与“接近爆发”和“相对连续”活动的脑电图更快恢复正常相关（P≤0.03），这一发现在7日龄及以下的婴儿中更为明显。术中血清葡萄糖浓度与1年、4年和8年时的神经发育结局无关。
心肺转流后低血糖倾向于与脑电图癫痫发作和脑电图恢复较慢相关，与CA持续时间无关。高血糖浓度与更差的神经发育结局无关。对于接受心脏手术的婴儿，避免低血糖可能比限制血糖更可取。
