O'Dougherty M, Wright F S, Garmezy N, Loewenson R B, Torres F
Child Dev. 1983 Oct;54(5):1129-42.
A model of risk potential for developmental outcome was created based on cardiac, medical, surgical, and family-stress factors in 31 children with transposition of the great arteries who had undergone reparative open heart surgery utilizing cardiopulmonary bypass during infancy. Impact of these potential risk factors was assessed by 4 current neurologic measures (neurologic anatomic abnormalities, functional impairment, electroencephalograph [EEG], and Pattern Visual Evoked Potential [PVEP]) and 4 psychologic measures (IQ, achievement, perceptual-motor function, and behavior). Results indicated that adverse developmental outcome was significantly associated with the following medical risk variables: failure of palliative surgery to alleviate hypoxia, prolonged hypoxia, growth failure, congestive heart failure, absence of ameliorating shunting heart defects, stroke, and CNS infection; and two psychosocial moderator variables: socioeconomic status and current life stress. Analysis of a "cumulative risk score" indicated significantly higher risk scores in children with abnormal EEGs, PVEPs, and neurologic examinations. The cumulative risk score highly correlated with composite neurologic outcome (r = .62), IQ (r = -.66), achievement (r = -.60), and perceptual-motor function (r = -.48). While overall outcome was favorable for children with TGA who experienced a single risk event, outcome was compromised if multiple risk factors occurred.
基于31例在婴儿期接受了利用体外循环进行的大血管转位修复性心脏直视手术的患儿的心脏、医学、手术及家庭压力因素，建立了发育结局风险潜力模型。通过4种当前的神经学测量方法（神经解剖学异常、功能损害、脑电图[EEG]和图形视觉诱发电位[PVEP]）和4种心理学测量方法（智商、学业成绩、感知运动功能和行为）评估这些潜在风险因素的影响。结果表明，不良发育结局与以下医学风险变量显著相关：姑息性手术未能缓解缺氧、长期缺氧、生长发育迟缓、充血性心力衰竭、无改善分流的心脏缺陷、中风和中枢神经系统感染；以及两个社会心理调节变量：社会经济地位和当前生活压力。对“累积风险评分”的分析表明，脑电图、图形视觉诱发电位和神经学检查异常患儿的风险评分显著更高。累积风险评分与综合神经学结局（r = 0.62）、智商（r = -0.66）、学业成绩（r = -0.60）和感知运动功能（r = -0.48）高度相关。虽然对于经历单一风险事件的大血管转位患儿总体结局良好，但如果出现多个风险因素，结局会受到影响。
