先天性膈疝患者在接受不同类型手术治疗时的神经心血管耦合。
Neurocardiovascular coupling in congenital diaphragmatic hernia patients undergoing different types of surgical treatment.
机构信息
From the Department of Electrical Engineering, ESAT-STADIUS, KU Leuven, Leuven, Belgium (DH, SVH), Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands (SAC, RW, DT), Department of Development and Regeneration, KU Leuven, Leuven, Belgium (GN), Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium (GN), Department of Anaesthesiology, Erasmus MC, Rotterdam, the Netherlands (JdG), Department of Pediatric Surgery (KZ, LW), Neonatal Intensive Care Unit, University Hospital Mannheim, Mannheim, Germany (APO) and Applied Mathematics and Computer Science, School of Engineering, Science and Technology, Universidad del Rosario, Bogotá, Colombia (AC).
出版信息
Eur J Anaesthesiol. 2022 Aug 1;39(8):662-672. doi: 10.1097/EJA.0000000000001642. Epub 2021 Dec 1.
BACKGROUND
The effect of peri-operative management on the neonatal brain is largely unknown. Triggers for perioperative brain injury might be revealed by studying changes in neonatal physiology peri-operatively.
OBJECTIVE
To study neonatal pathophysiology and cerebral blood flow regulation peri-operatively using the neuro-cardiovascular graph.
DESIGN
Observational, prospective cohort study on perioperative neuromonitoring. Neonates were included between July 2018 and April 2020.
SETTING
Multicentre study in two high-volume tertiary university hospitals.
PATIENTS
Neonates with congenital diaphragmatic hernia were eligible if they received surgical treatment within the first 28 days of life. Exclusion criteria were major cardiac or chromosomal anomalies, or syndromes associated with altered cerebral perfusion or major neurodevelopmental impairment. The neonates were stratified into different groups by type of peri-operative management.
INTERVENTION
Each patient was monitored using near-infrared spectroscopy and EEG in addition to the routine peri-operative monitoring. Neurocardiovascular graphs were computed off-line.
MAIN OUTCOME MEASURES
The primary endpoint was the difference in neurocardiovascular graph connectivity in the groups over time.
RESULTS
Thirty-six patients were included. The intraoperative graph connectivity decreased in all patients operated upon in the operation room (OR) with sevoflurane-based anaesthesia ( P < 0.001) but remained stable in all patients operated upon in the neonatal intensive care unit (NICU) with midazolam-based anaesthesia. Thoracoscopic surgery in the OR was associated with the largest median connectivity reduction (0.33 to 0.12, P < 0.001) and a loss of baroreflex and neurovascular coupling. During open surgery in the OR, all regulation mechanisms remained intact. Open surgery in the NICU was associated with the highest neurovascular coupling values.
CONCLUSION
Neurocardiovascular graphs provided more insight into the effect of the peri-operative management on the pathophysiology of neonates undergoing surgery. The neonate's clinical condition as well as the surgical and the anaesthesiological approach affected the neonatal physiology and CBF regulation mechanisms at different levels.
TRIAL REGISTRATION
NL6972, URL: https://www.trialre-gister.nl/trial/6972 .
背景
围手术期管理对新生儿大脑的影响在很大程度上尚不清楚。通过研究围手术期新生儿生理学的变化，可能揭示围手术期脑损伤的触发因素。
目的
使用神经心血管图研究围手术期新生儿的病理生理学和脑血流调节。
设计
围手术期神经监测的观察性前瞻性队列研究。纳入 2018 年 7 月至 2020 年 4 月期间接受手术治疗的先天性膈疝新生儿。
地点
两家大容量三级大学医院的多中心研究。
患者
如果新生儿在生命的头 28 天内接受手术治疗，则符合接受先天性膈疝手术治疗的条件。排除标准为主要心脏或染色体异常，或与脑灌注改变或主要神经发育障碍相关的综合征。根据围手术期管理的类型，将新生儿分为不同的组。
干预
除常规围手术期监测外，每位患者均接受近红外光谱和脑电图监测。离线计算神经心血管图。
主要观察指标
主要终点是各组随时间的神经心血管图连通性的差异。
结果
共纳入 36 例患者。在接受七氟醚全身麻醉的手术室（OR）中进行手术的所有患者（P<0.001）的术中图形连通性降低，但在接受咪达唑仑全身麻醉的新生儿重症监护病房（NICU）中进行手术的所有患者中保持稳定。在 OR 中进行的胸腔镜手术与最大的中位数连通性降低相关（0.33 至 0.12，P<0.001），并丧失了压力反射和神经血管耦合。在 OR 中进行开放性手术时，所有调节机制均保持完整。NICU 中的开放性手术与最高的神经血管耦合值相关。
结论
神经心血管图提供了更多关于围手术期管理对手术新生儿病理生理学影响的见解。新生儿的临床状况以及手术和麻醉方法在不同层面上影响了新生儿的生理和 CBF 调节机制。
试验注册
NL6972，网址：https://www.trialre-ister.nl/trial/6972。
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