Naguib Aymen N, Winch Peter D, Tobias Joseph D, Yeates Keith O, Miao Yongjie, Galantowicz Mark, Hoffman Timothy M
Department of Anesthesiology, Section of Critical Care Medicine, College of Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA ; The Heart Center, Section of Critical Care Medicine, College of Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
Department of Pediatrics, Section of Critical Care Medicine, College of Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
Saudi J Anaesth. 2015 Jan;9(1):12-8. doi: 10.4103/1658-354X.146255.
Modulating the stress response and perioperative factors can have a paramount impact on the neurodevelopmental outcome of infants who undergo cardiac surgery utilizing cardiopulmonary bypass.
In this single center prospective follow-up study, we evaluated the impact of three different anesthetic techniques on the neurodevelopmental outcomes of 19 children who previously underwent congenital cardiac surgery within their 1(st) year of life. Cases were done from May 2011 to December 2013. Children were assessed using the Stanford-Binet Intelligence Scales (5(th) edition). Multiple regression analysis was used to test different parental and perioperative factors that could significantly predict the different neurodevelopmental outcomes in the entire cohort of patients.
When comparing the three groups regarding the major cognitive scores, a high-dose fentanyl (HDF) patients scored significantly higher than the low-dose fentanyl (LDF) + dexmedetomidine (DEX) (LDF + DEX) group in the quantitative reasoning scores (106 ± 22 vs. 82 ± 15 P = 0.046). The bispectral index (BIS) value at the end of surgery for the -LDF group was significantly higher than that in LDF + DEX group (P = 0.011). For the entire cohort, a strong correlation was seen between the standard verbal intelligence quotient (IQ) score and the baseline adrenocorticotropic hormone level, the interleukin-6 level at the end of surgery and the BIS value at the end of the procedure with an R(2) value of 0.67 and P < 0.04. There was an inverse correlation between the cardiac Intensive Care Unit length of stay and the full-scale IQ score (R = 0.4675 and P 0.027).
Patients in the HDF group demonstrated overall higher neurodevelopmental scores, although it did not reach statistical significance except in fluid reasoning scores. Our results may point to a possible correlation between blunting the stress response and improvement of the neurodevelopmental outcome.
调节应激反应和围手术期因素对接受体外循环心脏手术的婴儿的神经发育结局可能产生至关重要的影响。
在这项单中心前瞻性随访研究中，我们评估了三种不同麻醉技术对19名在1岁以内接受先天性心脏手术的儿童神经发育结局的影响。病例研究时间为2011年5月至2013年12月。使用斯坦福-比奈智力量表（第5版）对儿童进行评估。采用多元回归分析来检验不同的父母及围手术期因素，这些因素可能显著预测整个患者队列中不同的神经发育结局。
在比较三组的主要认知得分时，高剂量芬太尼（HDF）组患者在定量推理得分方面显著高于低剂量芬太尼（LDF）+右美托咪定（DEX）（LDF + DEX）组（106±22 vs. 82±15，P = 0.046）。LDF组手术结束时的脑电双频指数（BIS）值显著高于LDF + DEX组（P = 0.011）。对于整个队列，标准言语智商（IQ）得分与基线促肾上腺皮质激素水平、手术结束时的白细胞介素-6水平以及手术结束时的BIS值之间存在强相关性，R²值为0.67，P < 0.04。心脏重症监护病房住院时间与全量表IQ得分呈负相关（R = 0.4675，P = 0.027）。
HDF组患者总体神经发育得分较高，尽管除流体推理得分外未达到统计学意义。我们的结果可能表明减轻应激反应与改善神经发育结局之间可能存在关联。
