Department of Anesthesiology, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.
Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai, China.
Sci Rep. 2020 Mar 10;10(1):4439. doi: 10.1038/s41598-020-61428-x.
The safety and efficacy of selective antegrade cerebral perfusion (SACP) in children undergoing aortic arch surgery are unclear. In this retrospective analysis, we compared moderate hypothermic circulatory arrest (MHCA; n = 61) plus SACP vs deep hypothermic circulatory arrest (DHCA; n = 53) in children undergoing aortic arch surgery during a period from January 2008 to December 2017. Demographic characteristics and the underlying anomalies were comparable between the two groups. The MHCA + SACP group had shorter cardiopulmonary bypass (CPB) time (146.9 ± 40.6 vs 189.6 ± 41.2 min for DHCA; p < 0.05) and higher nasopharyngeal temperature (26.0 ± 2.1 vs 18.9 ± 1.6 °C; p < 0.01). The MHCA + SACP group had lower rate of neurologic complications (3/61 vs 10/53 for DHCA; p < 0.05) but not complications in other organ systems. The MHCA + SACP group also had less 24-hour chest drainage (median, interquartile rage: 28.9, 12.6-150.0 vs 47.4, 15.2-145.0 ml/kg for DHCA; p < 0.05), shorter duration of postoperative mechanical ventilation (35.0, 15.4-80.3 vs 94.0, 42.0-144.0 h; p < 0.01), and shorter stay in intensive care unit (3.9, 3.0-7.0 vs 7.7, 5.0-15.0 d; p < 0.05). In regression analysis, in-hospital mortality was associated with longer CPB time. In conclusion, MHCA + SACP is associated with better short-term outcomes in children receiving aortic arch surgery under CPB.
在接受主动脉弓手术的儿童中，选择性顺行脑灌注（SACP）的安全性和有效性尚不清楚。在这项回顾性分析中，我们比较了中低温体外循环（MHCA；n=61）加 SACP 与深低温体外循环（DHCA；n=53）在 2008 年 1 月至 2017 年 12 月期间接受主动脉弓手术的儿童中的应用。两组患者的人口统计学特征和基础异常均无差异。MHCA+SACP 组体外循环时间更短（146.9±40.6 与 189.6±41.2 分钟，DHCA；p<0.05），鼻咽温度更高（26.0±2.1 与 18.9±1.6°C；p<0.01）。MHCA+SACP 组神经并发症发生率较低（3/61 与 10/53，DHCA；p<0.05），但其他器官系统并发症发生率无差异。MHCA+SACP 组 24 小时胸腔引流量也较少（中位数，四分位间距：28.9，12.6-150.0 与 47.4，15.2-145.0ml/kg，DHCA；p<0.05），术后机械通气时间更短（35.0，15.4-80.3 与 94.0，42.0-144.0h；p<0.01），重症监护病房停留时间更短（3.9，3.0-7.0 与 7.7，5.0-15.0d；p<0.05）。在回归分析中，住院死亡率与体外循环时间较长有关。总之，在接受 CPB 治疗的主动脉弓手术儿童中，MHCA+SACP 与更好的短期结果相关。
