Leth-Olsen Martin, Døhlen Gaute, Torp Hans, Nyrnes Siri Ann
Department of Circulation and Medical Imaging (ISB), Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
Children's Clinic, St Olav's University Hospital, Trondheim, Norway.
Pediatr Res. 2025 Feb;97(2):625-633. doi: 10.1038/s41390-024-03161-z. Epub 2024 Apr 3.
In this pilot study, we investigated continuous cerebral blood flow velocity measurements to explore cerebrovascular hemodynamics in infants with congenital heart disease undergoing cardiac surgery.
A non-invasive transfontanellar cerebral Doppler monitor (NeoDoppler) was used to monitor 15 infants (aged eight days to nine months) during cardiac surgery with cardiopulmonary bypass. Numerical and visual analyses were conducted to assess trends and events in Doppler measurements together with standard monitoring equipment. The mean flow index, calculated as the moving Pearson correlation between mean arterial pressure and time averaged velocity, was utilized to evaluate dynamic autoregulation. Two levels of impaired autoregulation were defined (Mean flow index >0.3/0.45), and percentage of time above these limits were calculated.
High quality recordings were achieved during 90.6% of the monitoring period. There was a significant reduction in time averaged velocity in all periods of cardiopulmonary bypass. All patients showed a high percentage of time with impaired dynamic autoregulation, with Mean flow index >0.3 and 0.45: 73.71% ± 9.06% and 65.16% ± 11.27% respectively. Additionally, the system promptly detected hemodynamic events.
Continuous transfontanellar cerebral Doppler monitoring could become an additional tool in enhancing cerebral monitoring in infants during cardiac surgery.
This pilot study demonstrates the feasibility of continuous transfontanellar Doppler monitoring of cerebral blood flow velocities during cardiac surgery in infants. It also demonstrates a high proportion of time with impaired cerebral autoregulation during cardiac surgery based on the Mean flow index. Continuous transfontanellar Doppler could become a useful tool to improve cerebral monitoring and provide new pathophysiological insight.
在这项初步研究中，我们调查了连续脑血流速度测量，以探索接受心脏手术的先天性心脏病婴儿的脑血管血流动力学。
使用无创经囟门脑多普勒监测仪（NeoDoppler）在15名婴儿（年龄8天至9个月）进行体外循环心脏手术期间进行监测。进行数值和视觉分析，以评估多普勒测量的趋势和事件以及标准监测设备。平均血流指数通过平均动脉压与时间平均速度之间的移动皮尔逊相关性计算得出，用于评估动态自动调节。定义了两个自动调节受损水平（平均血流指数>0.3/0.45），并计算了高于这些限值的时间百分比。
在90.6%的监测期内获得了高质量记录。在体外循环的所有阶段，时间平均速度均显著降低。所有患者的动态自动调节受损时间百分比均较高，平均血流指数>0.3和0.45时分别为73.71%±9.06%和65.16%±11.27%。此外，该系统能迅速检测到血流动力学事件。
连续经囟门脑多普勒监测可成为加强婴儿心脏手术期间脑监测的一种辅助工具。
这项初步研究证明了在婴儿心脏手术期间连续经囟门多普勒监测脑血流速度的可行性。它还表明，基于平均血流指数，心脏手术期间脑自动调节受损的时间比例较高。连续经囟门多普勒监测可成为改善脑监测并提供新的病理生理学见解的有用工具。
