Hövels-Gürich H H, Seghaye M C, Däbritz S, Messmer B J, von Bernuth G
Department of Pediatric Cardiology, RWTH Aachen, Germany.
J Thorac Cardiovasc Surg. 1997 Oct;114(4):578-85. doi: 10.1016/S0022-5223(97)70047-3.
The developmental status of children beyond 3 years of age after the neonatal arterial switch operation has not yet been systematically evaluated and is the topic of the present work.
Seventy-seven unselected children operated on as neonates with combined deep hypothermic circulatory arrest and low-flow cardiopulmonary bypass were examined at an age of 3.2 to 9.4 years (5.4 +/- 1.6 years, mean +/- standard deviation). Clinical neurologic status, standard scores of intelligence, acquired abilities and vocabulary, and standardized tests on gross motor and fine motor functions were carried out, and the results were related to preoperative, perioperative, and postoperative status and management.
Neurologic impairment was more frequent (9.1%) than in the normal population. Intelligence was not different in these patients compared with normal children (p = 0.11), but motor function, vocabulary, and acquired abilities were poorer. Reduced intelligence was found in 9.1%, fine motor dysfunction in 22.1%, and gross motor dysfunction in 23.4% of the children. Intelligence was weakly but significantly inversely related to the duration of bypass (Spearman correlation coefficient -0.25, p = 0.03) and tended to be inversely related to the duration of circulatory arrest (-0.21, p = 0.07), but not to core cooling time on bypass or degree of hypothermia. Gross motor function, vocabulary, and acquired abilities were not significantly related to any of the perioperative parameters considered. No correlation was found between the test results and the variables perinatal asphyxia, perioperative and postoperative cardiocirculatory insufficiency, resuscitation events, and plexal or intraventricular cerebral hemorrhage.
The neonatal arterial switch operation with combined circulatory arrest and low-flow bypass in our experience is associated with neurologic as well as fine and gross motor impairment but appears to be well tolerated concerning cognitive functions as based on formal intelligence testing.
新生儿动脉调转手术后3岁以上儿童的发育状况尚未得到系统评估，这是本研究的主题。
对77例未经挑选、新生儿期接受了深低温循环停搏联合低流量体外循环手术的儿童进行检查，年龄在3.2至9.4岁之间（平均5.4±1.6岁，均值±标准差）。进行了临床神经学状况、智力标准评分、后天能力和词汇测试，以及粗大运动和精细运动功能的标准化测试，并将结果与术前、围手术期和术后状况及处理相关联。
神经功能损害比正常人群更常见（9.1%）。与正常儿童相比，这些患者的智力无差异（p = 0.11），但运动功能、词汇和后天能力较差。9.1%的儿童存在智力降低，22.1%存在精细运动功能障碍，23.4%存在粗大运动功能障碍。智力与体外循环时间呈弱但显著的负相关（斯皮尔曼相关系数-0.25，p = 0.03），且倾向于与循环停搏时间呈负相关（-0.21，p = 0.07），但与体外循环时的核心降温时间或低温程度无关。粗大运动功能、词汇和后天能力与所考虑的任何围手术期参数均无显著相关性。测试结果与围产期窒息、围手术期和术后心循环功能不全、复苏事件以及脑丛或脑室内出血等变量之间未发现相关性。
根据我们的经验，新生儿动脉调转手术联合循环停搏和低流量体外循环与神经功能以及精细和粗大运动损害相关，但基于正式智力测试，在认知功能方面似乎耐受性良好。
