一期姑息术后高血糖不会对单心室生理患者 1 岁时的神经发育结局产生不良影响。
Hyperglycaemia after Stage I palliation does not adversely affect neurodevelopmental outcome at 1 year of age in patients with single-ventricle physiology.
机构信息
The Children's Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Eur J Cardiothorac Surg. 2009 Oct;36(4):688-93. doi: 10.1016/j.ejcts.2009.04.021. Epub 2009 Aug 20.
OBJECTIVE
Hyperglycaemia has been associated with worse outcome following traumatic brain injury and cardiac surgery in adults. We have previously reported no relationship between early postoperative hyperglycaemia and worse neurodevelopmental outcome at 1 year following biventricular repair of congenital heart disease. It is not known if postoperative hyperglycaemia results in worse neurodevelopmental outcome after infant cardiac surgery for single-ventricle lesions.
METHODS
Secondary analysis of postoperative glucose levels in infants <6 months of age undergoing Stage I palliation for various forms of single ventricle with arch obstruction. The patients were enrolled in a prospective study of genetic polymorphisms and neurodevelopmental outcomes assessed at 1 year of age with the Bayley Scales of Infant Development-II yielding two indices: mental developmental index (MDI) and psychomotor developmental index (PDI).
RESULTS
Stage I palliation was performed on 162 infants with 13 hospital and 15 late deaths (17.3% 1-year mortality). Neurodevelopmental evaluation was performed in 89 of 134 (66.4%) survivors. Glucose levels at admission to the cardiac intensive care unit and during the first 48 postoperative hours were available for 85 of 89 (96%) patients. Mean admission glucose value was 274+/-91 mg dl(-1); the maximum was 291+/-90 mg dl(-1), with 69 of 85 (81%) patients having at least one glucose value >200 mg dl(-1). Only two patients had a value <50 mg dl(-1). Mean MDI and PDI scores were 88+/-16 and 71+/-18, respectively. There were no statistically significant correlations between initial, mean, minimum or maximum glucose measurements and MDI or PDI scores. Only delayed sternal closure resulted in a statistically significant relationship between initial, minimum and maximum glucose values within the context of a multivariate analysis of variance model.
CONCLUSIONS
Hyperglycaemia following Stage I palliation in the neonatal period was not associated with lower MDI or PDI scores at 1 year of age.
目的
高血糖与成人创伤性脑损伤和心脏手术后的不良预后有关。我们之前报告称，在接受双心室修复先天性心脏病后 1 年，术后早期高血糖与神经发育不良结局之间没有关系。目前尚不清楚在婴儿心脏手术治疗单心室病变后，术后高血糖是否会导致更差的神经发育结局。
方法
对接受各种形式的单心室伴弓部梗阻行一期姑息术的 <6 个月龄婴儿的术后血糖水平进行二次分析。这些患者被纳入一项前瞻性研究，研究内容为遗传多态性与 1 岁时神经发育结局的关系，采用贝利婴幼儿发育量表-II 进行评估，得到两个指数：精神运动发育指数（MDI）和心理运动发育指数（PDI）。
结果
162 名婴儿接受了一期姑息术，其中 13 名患儿住院期间死亡，15 名患儿晚期死亡（17.3%的 1 年死亡率）。134 例存活患儿中有 89 例（66.4%）进行了神经发育评估。89 例存活患儿中有 85 例（96%）患儿的心脏重症监护病房入院时和术后前 48 小时的血糖水平可用。入院时的平均血糖值为 274±91mg/dL；最高值为 291±90mg/dL，85 例中有 69 例（81%）至少有一次血糖值>200mg/dL。只有 2 例患儿血糖值<50mg/dL。平均 MDI 和 PDI 评分分别为 88±16 和 71±18。初始、平均、最低或最高血糖测量值与 MDI 或 PDI 评分之间无统计学显著相关性。只有延迟胸骨闭合与初始、最低和最高血糖值之间的多变量方差模型分析有统计学显著关系。
结论
新生儿期接受一期姑息术治疗后，高血糖与 1 岁时的 MDI 或 PDI 评分较低无关。
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