Mackie Andrew S, Vatanpour Shabnam, Alton Gwen Y, Dinu Irina A, Ryerson Lindsay, Moddemann Diane M, Thomas Petrie Julie
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada.
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Ann Thorac Surg. 2015 Jun;99(6):2124-32. doi: 10.1016/j.athoracsur.2015.02.029. Epub 2015 Apr 22.
The purpose of this study was to determine whether a clinical outcome score derived from early postoperative events is associated with Bayley-III scores at 18 to 24 months among infants undergoing cardiopulmonary bypass surgery.
Included were infants aged 6 weeks or less who underwent surgery between 2005 and 2009, all of whom were referred for neurodevelopmental evaluation at 18 to 24 months. We excluded children with chromosomal abnormalities. The prespecified clinical outcome score had a range of 0 to 7. Lower scores indicated a more rapid postoperative recovery. Patients requiring extracorporeal life support were assigned a score of 7.
One hundred and ninety-nine subjects were included. Surgical procedures were arterial switch (72), Norwood (60), repair of total anomalous pulmonary venous connection (29), and other (38). Nine subjects had postoperative extracorporeal life support. Mean clinical outcome score in the Norwood group was 4.0 ± 1.4 versus the arterial switch group (2.6 ± 1.5, p < 0.001), total anomalous pulmonary venous connection group (2.8 ± 1.8, p < 0.01), and other group (4.0 ± 1.8, p = not significant). Among children who had a clinical outcome score of 4 or greater, there was a decrease in Bayley-III cognitive score of 5.7 (95% confidence interval: 1.5 to 9.9, p = 0.009), a decrease in language score of 10.0 (95% confidence interval: 4.9 to 15.1, p < 0.001), and a decrease in motor score of 9.7 (95% confidence interval: 4.8 to 14.5, p < 0.001). Time until lactate of 2.0 mmol/L or less and highest 24-hour inotrope score increased with increasing clinical outcome score (p < 0.0001).
Clinical outcome scores of 4 or greater were associated with significantly lower Bayley-III scores at 18 to 24 months. This score may be valuable as an endpoint when evaluating novel potential therapies for this high-risk population.
本研究的目的是确定从术后早期事件得出的临床结局评分是否与接受体外循环手术的婴儿在18至24个月时的贝利婴幼儿发展量表第三版（Bayley-III）评分相关。
纳入2005年至2009年间接受手术的6周龄及以下婴儿，所有婴儿均在18至24个月时接受神经发育评估。我们排除了患有染色体异常的儿童。预先设定的临床结局评分范围为0至7分。分数越低表明术后恢复越快。需要体外生命支持的患者评分为7分。
共纳入199名受试者。手术方式包括动脉调转术（72例）、诺伍德手术（Norwood手术，60例）、完全性肺静脉异位连接修复术（29例）和其他手术（38例）。9名受试者术后接受了体外生命支持。诺伍德组的平均临床结局评分为4.0±1.4，而动脉调转术组为（2.6±1.5，p<0.001），完全性肺静脉异位连接组为（2.8±1.8，p<0.01），其他组为（4.0±1.8，p=无显著差异）。在临床结局评分为4分或更高的儿童中，贝利婴幼儿发展量表第三版认知评分下降了5.7分（95%置信区间：1.5至9.9，p=0.009），语言评分下降了10.0分（95%置信区间：4.9至15.1，p<0.001），运动评分下降了9.7分（95%置信区间：4.8至14.5，p<0.001）。乳酸水平降至2.0 mmol/L或更低所需时间以及最高24小时血管活性药物评分随临床结局评分升高而增加（p<0.0001）。
临床结局评分为4分或更高与18至24个月时显著更低的贝利婴幼儿发展量表第三版评分相关。在评估针对这一高危人群的新型潜在治疗方法时，该评分作为一个终点指标可能具有价值。
