Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
J Thorac Cardiovasc Surg. 2013 Feb;145(2):438-445.e1; discussion 444-5. doi: 10.1016/j.jtcvs.2012.10.033. Epub 2012 Dec 6.
The study objective was to expand on prior research examining intraoperative regional cerebral oxygen saturation (rSO(2)) measured by near-infrared spectroscopy (NIRS) by evaluating the predictive value of perioperative NIRS monitoring for neurodevelopmental outcomes after infant cardiac surgery.
Cross-sectional neurodevelopmental evaluation at 24 months of age with the Bayley Scales of Infant and Toddler Development, Third Edition was performed for patients who underwent cardiac surgery with perioperative NIRS monitoring between 2007 and 2010. Retrospective clinical data were extracted from the electronic medical record. Evaluation of selected NIRS measures, including preoperative rSO(2) (baseline) as well as rSO(2) nadir and percent decrease from baseline during the intraoperative and early postoperative periods, was undertaken.
Perioperative NIRS and neurodevelopmental data were available for 31 patients without chromosomal anomalies who underwent cardiac surgery during infancy at a median age of 0.43 months. Optimal thresholds on NIRS measures identified through receiver operating characteristic analyses were intraoperative percent decrease of 52% for receptive communication delay and postoperative rSO(2) nadir of 56% for cognitive delay and 49% for gross motor delay. When considered in conjunction with other clinical characteristics in stepwise linear regression analyses, intraoperative percent decrease of more than 52% entered into the final model for receptive communication outcome and postoperative rSO(2) nadir of less than 56% entered into the final model for cognitive outcome.
Perioperative NIRS monitoring seems to enhance the ability to predict neurodevelopmental outcome. Specific NIRS measures associated with neurodevelopmental outcome, as well as optimal thresholds, seem to differ across the continuum of the perioperative period.
本研究旨在扩展先前使用近红外光谱（NIRS）测量术中局部脑氧饱和度（rSO₂）的研究，评估围术期 NIRS 监测对婴儿心脏手术后神经发育结局的预测价值。
对 2007 年至 2010 年间接受心脏手术且围术期进行 NIRS 监测的患者，在 24 个月龄时采用《贝利婴幼儿发育量表，第三版》进行横向神经发育评估。从电子病历中提取回顾性临床数据。对选定的 NIRS 指标进行评估，包括术前 rSO₂（基线）以及术中及术后早期 rSO₂最低值和与基线相比的下降百分比。
共有 31 例无染色体异常的婴儿在 0.43 月龄时接受心脏手术，围术期有 NIRS 和神经发育数据。通过接受者操作特征分析确定的 NIRS 指标最佳阈值为术中 rSO₂下降 52%与接受性交流延迟相关，术后 rSO₂最低值 56%与认知延迟相关，49%与粗大运动延迟相关。在逐步线性回归分析中，将术中 rSO₂下降超过 52%与其他临床特征结合考虑，作为接受性交流结局的最终模型进入，术后 rSO₂最低值低于 56%作为认知结局的最终模型进入。
围术期 NIRS 监测似乎可提高预测神经发育结局的能力。与神经发育结局相关的特定 NIRS 指标以及最佳阈值似乎在围术期不同时间段存在差异。
