Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.
Ann Thorac Surg. 2014 Jul;98(1):125-32. doi: 10.1016/j.athoracsur.2014.03.035. Epub 2014 May 10.
Cerebral blood flow velocity (CBFV) measured by transcranial Doppler sonography has provided information on cerebral perfusion in patients undergoing infant heart surgery, but no studies have reported a relationship to early postoperative and long-term neurodevelopmental outcomes.
CBFV was measured in infants undergoing biventricular repair without aortic arch reconstruction as part of a trial of hemodilution during cardiopulmonary bypass (CPB); CBFV (Vm, mean; Vs, systolic; Vd, end-diastolic) in the middle cerebral artery and change in Vm (rVm) were measured intraoperatively and up to 18 hours post-CPB. Neurodevelopmental outcomes, measured at 1 year of age, included the psychomotor development index (PDI) and mental development index (MDI) of the Bayley Scales of Infant Development-II.
CBFV was measured in 100 infants; 43 with D-transposition of the great arteries, 36 with tetralogy of Fallot, and 21 with ventricular septal defects. Lower Vm, Vs, Vd, and rVm at 18 hours post-CPB were independently related to longer intensive care unit duration of stay (p<0.05). In the 85 patients who returned for neurodevelopmental testing, lower Vm, Vs, Vd, and rVm at 18 hours post-CPB were independently associated with lower PDI (p<0.05) and MDI (p<0.05, except Vs: p=0.06) scores. Higher Vs and rVm at 18 hours post-CPB were independently associated with increased incidence of brain injury on magnetic resonance imaging in 39 patients.
Postoperative CBFV after biventricular repair is related to early postoperative and neurodevelopmental outcomes at 1 year of age, possibly indicating that low CBFV is a marker of suboptimal postoperative hemodynamics and cerebral perfusion.
经颅多普勒超声测量的脑血流速度（CBFV）为接受婴儿心脏手术的患者提供了脑灌注信息，但尚无研究报告其与术后早期和长期神经发育结局之间的关系。
在接受双心室修复而不进行主动脉弓重建的婴儿中，作为体外循环（CPB）期间血液稀释试验的一部分，测量 CBFV；测量大脑中动脉的 CBFV（Vm，平均值；Vs，收缩期；Vd，舒张末期）和 Vm 的变化（rVm），并在术中及 CPB 后 18 小时进行测量。1 岁时的神经发育结局包括贝利婴幼儿发育量表-II 的精神运动发育指数（PDI）和精神发育指数（MDI）。
在 100 名婴儿中测量了 CBFV；43 名患有大动脉转位，36 名患有法洛四联症，21 名患有室间隔缺损。CPB 后 18 小时时较低的 Vm、Vs、Vd 和 rVm 与 ICU 停留时间较长（p<0.05）独立相关。在 85 名返回进行神经发育测试的患者中，CPB 后 18 小时时较低的 Vm、Vs、Vd 和 rVm 与较低的 PDI（p<0.05）和 MDI（除 Vs：p=0.06）评分独立相关。CPB 后 18 小时时较高的 Vs 和 rVm 与 39 名患者磁共振成像上脑损伤发生率增加独立相关。
双心室修复术后的术后 CBFV 与 1 岁时的术后早期和神经发育结局相关，可能表明低 CBFV 是术后血流动力学和脑灌注不佳的标志物。
