Vahsen N, Kavsek M, Toussaint-Götz N, Schneider K, Urban A E, Schneider M
Deutsches Kinderherzzentrum Sankt Augustin, St. Augustin.
Klin Padiatr. 2009 Jan-Feb;221(1):19-24. doi: 10.1055/s-2007-985863. Epub 2008 Feb 12.
Empirical results about the cognitive, motor and psychic development in patients with d-transposition of the great arteries after arterial switch operation remain unclear. Potential reasons are the patients' initial status, improved perinatal care or the quality of surgery. To exclude quality of surgery as the main reason, only children, who were operated by the same surgeon, were included in this study.
Thirty children operated as neonates were examined at the age of 4.3 to 12.5 years.
The Kaufman-Assessment Battery for Children (K-ABC) was administered to assess general intelligence and acquired abilities, the Movement Assessment Battery for Children (M-ABC) to assess gross and fine motor function and the Child Behaviour Checklist (CBCL/4-18) to assess behaviour problems.
General intelligence was significantly lower than the population means, whereas the acquired abilities were within the normal range. Motor function also was below average. Parents reported significantly more behaviour problems in patients compared to the normal population. Risk factors for lower general intelligence were the duration of the operation and postoperative complications.
The arterial switch operation performed during the neonatal period is associated with lower general intelligence, motor impairment and behaviour problems. Careful assessment of neurodevelopmental outcome for the detection of developmental delays and early initiation of interventions seem to be necessary.
大动脉d型转位患儿在动脉调转手术后认知、运动及心理发育的实证结果仍不明确。潜在原因包括患儿的初始状态、围产期护理的改善或手术质量。为排除手术质量作为主要原因，本研究仅纳入由同一位外科医生实施手术的儿童。
30例新生儿期接受手术的儿童在4.3至12.5岁时接受检查。
采用考夫曼儿童评估成套测验（K-ABC）评估一般智力和后天能力，运动评估量表（M-ABC）评估粗大和精细运动功能，儿童行为量表（CBCL/4-18）评估行为问题。
一般智力显著低于总体均值，而后天能力在正常范围内。运动功能也低于平均水平。与正常人群相比，家长报告患儿存在更多行为问题。一般智力较低的危险因素为手术持续时间和术后并发症。
新生儿期实施的动脉调转手术与较低的一般智力、运动功能障碍及行为问题相关。似乎有必要对神经发育结局进行仔细评估以发现发育迟缓并尽早开展干预。
