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原创文章——小儿心脏手术后神经并发症及短期预后的危险因素:一项回顾性分析。

Original Article--Risk Factors for Neurological Complications and Short-term Outcomes After Pediatric Heart Surgery: A Retrospective Analysis.

作者信息

Shahzad Muhammad, Alheraish Yasser A, Algethami Bushra, Algheryafi Linah A, Kamel Salma, Ghunaim Rawan, Alhalees Zohair Y

机构信息

Department of Critical Care, King Faisal Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.

Department of Medicine, King Faisal University, Riyadh, Kingdom of Saudi Arabia.

出版信息

J Saudi Heart Assoc. 2024 Mar 3;36(1):8-13. doi: 10.37616/2212-5043.1364. eCollection 2024.

Abstract

OBJECTIVE

To assess the risk factors associated with neurological complications and poor short-term outcomes following pediatric heart surgery.

METHODOLOGY

A cross-sectional study was conducted in a cardiac intensive care unit between June 2019 and June 2022. The data of all children less than 15 years old who underwent open-heart surgery and had CT brain were extracted from hospital records. The primary outcome was the incidence of CNS insult, and secondary outcomes included death after surgery, length of stay in ICU and hospital. Data analysis was performed using SPSS version 23, and a p-value less than or equal to 0.05 was considered statistically significant.

RESULTS

Total 1850 surgeries were performed in the specified period of time. The study included 208 children who had CT Brain, with a median age of 5 months. 2.81 % children had neurological complications, with 25 % of patients who had CT brain. The most common neurological complication was seizure (7.2 %). There were no significant differences observed between CNS insult and age, gender, syndrome, or prematurity (p > 0.05), except for a significant association between previous CNS insult and CNS insult after surgery (p = 0.001). Children with CNS insult had significantly higher ICU and hospital length of stay, mortality after surgery, and mortality within 2 weeks of surgery (p ≤ 0.05).

CONCLUSION

Seizure was most common neurological manifestation after cardiac surgeries in children. CNS insult after surgery was associated with worse outcomes, including longer hospital stays and increased mortality.

摘要

目的

评估小儿心脏手术后神经并发症及短期预后不良的相关危险因素。

方法

于2019年6月至2022年6月在心脏重症监护病房进行了一项横断面研究。从医院记录中提取了所有接受心脏直视手术且进行了脑部CT检查的15岁以下儿童的数据。主要结局是中枢神经系统损伤的发生率,次要结局包括术后死亡、在重症监护病房和医院的住院时间。使用SPSS 23版进行数据分析,p值小于或等于0.05被认为具有统计学意义。

结果

在指定时间段内共进行了1850例手术。该研究纳入了208名进行了脑部CT检查的儿童,中位年龄为5个月。2.81%的儿童出现神经并发症,在进行脑部CT检查的患者中占25%。最常见的神经并发症是癫痫发作(7.2%)。除既往中枢神经系统损伤与术后中枢神经系统损伤之间存在显著关联(p = 0.001)外,未观察到中枢神经系统损伤与年龄、性别、综合征或早产之间存在显著差异(p > 0.05)。出现中枢神经系统损伤的儿童在重症监护病房和医院的住院时间、术后死亡率以及术后2周内的死亡率显著更高(p≤0.05)。

结论

癫痫发作是小儿心脏手术后最常见的神经表现。术后中枢神经系统损伤与更差的预后相关,包括更长的住院时间和更高的死亡率。

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