Meyer Sascha, Poryo Martin, Shatat Mohammed, Gortner Ludwig, Abdul-Khaliq Hashim
Department of Pediatrics and Neonatology, Neuropediatrics Building 9, University Hospital of Saarland, Kirrbergerstr., 66421, Homburg/Saar, Germany.
Department of Pediatric Cardiology, University Hospital of Saarland, Homburg/Saar, Germany.
Wien Med Wochenschr. 2017 Sep;167(11-12):251-255. doi: 10.1007/s10354-017-0576-0. Epub 2017 Jun 28.
Neurological dysfunction may occur after corrective cardiac surgery using cardio-pulmonary bypass (CPB) with or without circulatory arrest. Different neurophysiological monitoring systems have been employed to detect neurological complications and possible brain injury in infants and children during and after cardiac surgery. The value of Elecetroencephalogram (EEG) in infants and children at risk for neurological sequelae has not been systematically studied.
Sequential performance of two EEGs before and after cardiac surgery at a tertiary University Hospital to screen for possible brain injury after cardiac surgery in neonates and children undergoing CPB surgery. In addition, a complete neurological examination and assessment by a physiotherapist was performed.
Over a 4-year period, in 313 patients (age: 54.2 ± 55.7 months; normal initial EEG) after cardiac surgery CPB (duration of surgery: 146.0 ± 58.9 min; aortic cross clamp time: 34.1 ± 19.1 min), a 19-channel EEG recording was performed 2.4 ± 1.8 days prior to and 11.6 ± 5.3 days after cardiac surgery. An abnormal EEG was detected in only 8 of 313 patients (2.5%; focal slowing: 1, generalised slowing: 5, epiletiform discharges: 2) after cardiac surgery, while the EEG was normal in the remaining 305 patients (97.5%). In 1 patient, an intra-cerebral pathology was seen on MRI (ischemic); in 5 patients, follow-up EEGs were performed, which revealed normalized findings. None of the 8 patients demonstrated new focal neurological deficits on physical examination, but 33 (9.7%) children demonstrated minor abnormalities (e.g., subtle motor asymmetry, increase in muscle tone, etc.), which were unrelated to abnormal EEG findings.
According to the used protocol, pathological EEG findings were very infrequent in our study cohort. The routine and indiscriminative recording of EEGs in children before and after corrective or palliative cardiac surgery for congenital heart disease using CPB is not recommended. Further intra-operative neuromonitoring methods with immediate intervention should be evaluated.
在使用体外循环（CPB）进行心脏矫正手术时，无论是否伴有循环骤停，都可能发生神经功能障碍。不同的神经生理监测系统已被用于检测婴幼儿心脏手术期间及术后的神经并发症和可能的脑损伤。脑电图（EEG）在有神经后遗症风险的婴幼儿中的价值尚未得到系统研究。
在一家三级大学医院，对接受CPB手术的新生儿和儿童在心脏手术前后进行连续两次脑电图检查，以筛查心脏手术后可能的脑损伤。此外，由物理治疗师进行全面的神经学检查和评估。
在4年期间，对313例心脏手术后接受CPB的患者（年龄：54.2±55.7个月；初始脑电图正常）（手术持续时间：146.0±58.9分钟；主动脉交叉钳夹时间：34.1±19.1分钟），在心脏手术前2.4±1.8天和术后11.6±5.3天进行了19通道脑电图记录。心脏手术后，313例患者中仅8例（2.5%）检测到脑电图异常（局灶性减慢：1例，广泛性减慢：5例，癫痫样放电：2例），其余305例患者（97.5%）脑电图正常。1例患者MRI显示脑内病变（缺血性）；5例患者进行了随访脑电图检查，结果显示正常。8例患者中无一例在体格检查中出现新的局灶性神经功能缺损，但33例（9.7%）儿童表现出轻微异常（如轻微运动不对称、肌张力增加等），这些与脑电图异常结果无关。
根据所采用的方案，在我们的研究队列中，病理性脑电图结果非常罕见。不建议对使用CPB进行先天性心脏病矫正或姑息性心脏手术的儿童在手术前后常规且不加区分地记录脑电图。应评估进一步的术中神经监测方法及立即干预措施。
