评估小儿体外循环后常规临床管理中 EEG 异常的术后危险因素。
Assessment of postoperative risk factors for EEG abnormalities in routine clinical management after paediatric cardiopulmonary bypass.
机构信息
Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong, China.
Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong, China.
出版信息
Interact Cardiovasc Thorac Surg. 2021 Jul 26;33(2):301-308. doi: 10.1093/icvts/ivab081.
OBJECTIVES
The postoperative risk factors for electroencephalogram(EEG) abnormalities after paediatric cardiopulmonary bypass (CPB) remain to be identified. We investigated the characteristics of EEG abnormalities and risk factors in routine clinical management post-CPB.
METHODS
EEG and cerebral oxygen saturation (ScO2) were monitored in 96 patients (aged 3 days, 37 months, median 5 months) for 72 h post-CPB. Clinical measurements included 4-hourly arterial and central venous pressure, arterial blood gases, doses of inotropic and vasoactive drugs, daily C-reactive protein (CRP) and NT-proB-type Natriuretic Peptide (NT-proBNP). Demographics, STAT categories and outcomes (duration of mechanical ventilation,CICU stay) were recorded. Un.
RESULTS
Seizures occurred in 20 patients (20.8%) beginning at 0-48 hand lasting 10 min-31 h; background abnormalities occurred in 67 (69.8%) beginning at 0-8 h and lasting 4-48 h. Patients with EEG abnormalities had worse outcomes. In univariable regression, seizures positively correlated with STAT categories, CPB time, temperature, blood pressure, central venous pressure, NT-proBNP, CRP, lactate and epinephrine, negatively with ScO2 and PaCO2 (P < 0.001 for lactate and epinephrine, P < 0.1 for the remaining). The degree of background abnormalities positively correlated with STAT categories, CPB time, operative time, central venous pressure, milrinone, negatively with blood pressure (P = 0.0003-0.087); it negatively correlated with lower dose of epinephrine (P < 0.001) and positively with higher dose (P = 0.03l). In multivariable regression, seizures positively correlated with epinephrine, lactate and temperature; the background abnormality correlations remain significant except for milrinone and operative time (P < 0.001 for epinephrine, P < 0.05 for the remaining).
CONCLUSIONS
Numerous perioperative risk factors are associated with EEG abnormalities post-CPB. The most significant and consistent risk factor is epinephrine.
目的
小儿体外循环（CPB）术后脑电图（EEG）异常的术后危险因素仍有待确定。我们研究了 CPB 后常规临床管理中 EEG 异常和危险因素的特征。
方法
对 96 例（年龄 3 天、37 个月，中位数 5 个月）患者进行 CPB 后 72 小时的 EEG 和脑氧饱和度（ScO2）监测。临床测量包括每 4 小时的动脉压和中心静脉压、动脉血气、正性肌力和血管活性药物剂量、每日 C 反应蛋白（CRP）和 N 末端 proB 型利钠肽（NT-proBNP）。记录人口统计学、STAT 类别和结果（机械通气时间、CICU 停留时间）。
结果
20 例（20.8%）患者在 0-48 小时内出现癫痫发作，持续 10 分钟-31 小时；67 例（69.8%）患者在 0-8 小时开始出现背景异常，持续 4-48 小时。EEG 异常患者的预后较差。在单变量回归中，癫痫发作与 STAT 类别、CPB 时间、体温、血压、中心静脉压、NT-proBNP、CRP、乳酸和肾上腺素呈正相关，与 ScO2 和 PaCO2 呈负相关（乳酸和肾上腺素 P<0.001，其余 P<0.1）。背景异常的严重程度与 STAT 类别、CPB 时间、手术时间、中心静脉压、米力农呈正相关，与血压呈负相关（P=0.0003-0.087）；与肾上腺素较低剂量呈正相关（P<0.001），与较高剂量呈负相关（P=0.031）。在多变量回归中，癫痫发作与肾上腺素、乳酸和体温呈正相关；除米力农和手术时间外，背景异常的相关性仍然显著（肾上腺素 P<0.001，其余 P<0.05）。
结论
许多围手术期危险因素与 CPB 后 EEG 异常有关。最显著和一致的危险因素是肾上腺素。
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