Wright M, Nolan T
Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
Arch Dis Child. 1994 Jul;71(1):64-70. doi: 10.1136/adc.71.1.64.
Surgical correction greatly decreases the mortality and cardiac morbidity of cyanotic congenital heart disease, but children remain at risk of long term difficulties in other areas. A historical cohort study was conducted to determine the relation between heart disease and school performance in 29 children aged 7 to 12 years old with simple transposition of the great arteries or tetralogy of Fallot. All children had surgical correction of their lesion before 2.5 years of age. Those at greater risk of school difficulties because of recognised complications of their heart disease or for reasons other than directly attributable to the heart disease were excluded. Comparison was made with 36 children who had presented with cardiac murmurs at a similar age, but who did not require treatment. Children with cyanotic disease showed significantly poorer performance in all academic areas assessed by the Wide Range Achievement Test-Revised; the difference in group mean score (adjusted for differences in maternal education, sex, and parental occupational prestige) for reading was 10.3 points (confidence interval (CI) 1.25 to 19.34), for spelling 7.8 (CI 1.11 to 14.52), and for arithmetic 6.8 (CI 0.19 to 13.39). The differences in adjusted group means for the Wechsler Intelligence Scale for Children-Revised full scale, performance and verbal IQs were significant, particularly the later at 10.1 points (CI 2.59 to 17.61). Teacher reports indicated significant differences in arithmetic when outcome was dichotomised to 'below grade' or 'not below grade'. There were no significant associations between outcome measures and the medical or perioperative parameters, however, including those related to hypoxia. It is concluded that the increased incidence of academic problems and the nature of the cognitive difficulties in children with uncomplicated corrective cardiac surgery for cyanotic heart disease are not fully explained by chronic hypoxia, or by other factors related to the cardiac surgery.
外科矫治术能大幅降低青紫型先天性心脏病的死亡率和心脏发病率，但患儿在其他方面仍有长期出现问题的风险。一项历史性队列研究旨在确定29名年龄在7至12岁、患有单纯性大动脉转位或法洛四联症的儿童的心脏病与学业成绩之间的关系。所有儿童均在2.5岁之前接受了病变的外科矫治术。因心脏病公认的并发症或其他并非直接归因于心脏病的原因而有更大学习困难风险的儿童被排除在外。将这些儿童与36名在相似年龄出现心脏杂音但无需治疗的儿童进行比较。通过修订版广泛成就测验评估，青紫型疾病患儿在所有学术领域的表现均显著较差；阅读方面的组平均得分差异（根据母亲教育程度、性别和父母职业声望差异进行调整）为10.3分（置信区间[CI] 1.25至19.34），拼写方面为7.8分（CI 1.11至14.52），算术方面为6.8分（CI 0.19至13.39）。修订版韦氏儿童智力量表全量表、操作智商和言语智商的调整后组均值差异显著，尤其是操作智商差异为10.1分（CI 2.59至17.61）。教师报告显示，当将结果分为“低于年级水平”或“不低于年级水平”时，算术方面存在显著差异。然而，结果测量与医学或围手术期参数之间没有显著关联，包括与缺氧相关的参数。研究得出结论，对于青紫型心脏病进行无并发症心脏矫治手术的儿童，学业问题发生率增加以及认知困难的性质不能完全用慢性缺氧或与心脏手术相关的其他因素来解释。
