Magruder J Trent, Hibino Narutoshi, Collica Sarah, Zhang Huaitao, Harness H Lynn, Heitmiller Eugenie S, Jacobs Marshall L, Cameron Duke E, Vricella Luca A, Everett Allen D
Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Interact Cardiovasc Thorac Surg. 2016 Oct;23(4):531-7. doi: 10.1093/icvts/ivw194. Epub 2016 Jun 16.
Protecting the brain during cardiac surgery is a major challenge. We evaluated associations between nadir oxygen delivery (DO2) during paediatric cardiac surgery and a biomarker of brain injury, glial fibrillary acidic protein (GFAP).
Blood samples were obtained during a prospective, single-centre observational study of children undergoing congenital heart surgery with cardiopulmonary bypass (CPB) (2010-2011). Remnant blood samples, collected serially prior to cannulation for bypass and until incision closure, were analysed for GFAP levels. Perfusion records were reviewed to calculate nadir DO2. Linear regression analysis was used to assess the association between nadir DO2 and GFAP levels.
A total of 116 consecutive children were included, with the median age of 0.75 years (interquartile range: 0.42-8.00) and the median weight of 8.3 kg (5.8-20.0). Single-ventricle anatomy was present in 19 patients (16.4%). Deep hypothermic circulatory arrest (DHCA) was used in 14 patients (12.1%). On univariable analysis, nadir DO2 was significantly associated with GFAP values measured during rewarming on CPB (P = 0.005) and after CPB decannulation (P = 0.02). On multivariable analysis controlling for CPB time, DHCA and procedure risk category, a significant negative relationship remained between nadir DO2 and post-CPB GFAP (P = 0.03).
Lower nadir DO2 is associated with increased GFAP levels, suggesting that diminished DO2 during paediatric heart surgery may be contributing to neurological injury. The DO2-GFAP relationship may provide a useful measure for the implementation of neuroprotective strategies in paediatric heart surgery, including goal-directed perfusion.
在心脏手术期间保护大脑是一项重大挑战。我们评估了小儿心脏手术期间最低氧输送量（DO2）与脑损伤生物标志物胶质纤维酸性蛋白（GFAP）之间的关联。
在一项对接受体外循环（CPB）先天性心脏手术儿童的前瞻性单中心观察性研究（2010 - 2011年）期间采集血样。在体外循环插管前直至切口关闭期间连续采集的剩余血样，用于分析GFAP水平。回顾灌注记录以计算最低DO2。采用线性回归分析评估最低DO2与GFAP水平之间的关联。
总共纳入了116名连续儿童，中位年龄为0.75岁（四分位间距：0.42 - 8.00），中位体重为8.3 kg（5.8 - 20.0）。19名患者（16.4%）存在单心室解剖结构。14名患者（12.1%）使用了深低温停循环（DHCA）。在单变量分析中，最低DO2与CPB复温期间（P = 0.005）及CPB拔管后（P = 0.02）测得的GFAP值显著相关。在控制CPB时间、DHCA和手术风险类别的多变量分析中，最低DO2与CPB后GFAP之间仍存在显著负相关（P = 0.03）。
较低的最低DO2与GFAP水平升高相关，提示小儿心脏手术期间DO2降低可能导致神经损伤。DO2 - GFAP关系可能为小儿心脏手术中实施神经保护策略（包括目标导向灌注）提供有用的衡量指标。
