先天性心脏病患儿术前认知功能的现况调查

Preoperative cognition of children with congenital heart disease

目的了解我国先天性心脏病患儿术前认知功能的现况。方法根据患儿不同年龄采用不同量表评估443例先天性心脏病患儿的认知状况，包括智商、运动及行为能力。结果大年龄组仅有49．0％的患儿智力发育合格，WISC组、WPPSI组的平均智商分（79．51±18．01）处于中下水平；小年龄组患儿认知发育合格率亦只有50．4%；智力发育指数（94．3±17．4）、运动发育指数（86．8±18．8）均低于平均水平（100）。小年龄组中复杂先天性心脏病组患儿认知低下发生率（62．6％）、智力发育迟缓发生率（56．4％）、运动迟缓发生率（63．7％）均明显高于其他组，智力发育指数（85．35±20．6）亦明显低于室间隔缺损组（95．1±18．7）、动脉导管未闭组（101．3±23．7）；复杂先天性心脏病组（75．4±20．3）、法乐四联症组（75．6±23．2）的运动发育指数明显低于室间隔缺损组（92．7±18．8），差异均有统计学意义。结论先天性心脏病影响患儿的认知功能，尤其是运动发育。

Objective To explore the preoperative cognition of children with congenital heart disease （CHD）. Methods The cognition （including intelligence, motion and behavior ability） profiles of 443 surgical CHD children were assessed with Wechsler intelligence scale for children （WISC）, Wechsler preschool ＆ primary scale of intelligence （WPPSI）, Peabody picture vocabulary test （PPVT） and Bayley scales of infant development II test （Bayley-II）. Results Only 49. 0% were normal in older group （〉3 years）. And the mean intelligence quotient （79. 51 ±18. 01） of those in WISC and WPPSI groups was below average quality. In younger group （〈3 years）, only 50.4% infants fulfilled the cognition standard. Both mental development index （MDh 94. 3±7.4） and psychological development index （PDI, 86. 8 ±18.8） were lower than average quality. The incidences of lower cognition （62. 6 % ）, mental retardation （56. 4% ） and bradykinesia （63.7 %） were higher in those with complicated CHD. MDI of children with complicated CHD （85.35± 20. 6）were obviously lower than those with ventricular septal defect （VSD, 95.1 ± 18. 7） and patent ductus arteriosus （PDA, 101.3 ± 23.7）. PDI children with complicated CHD （75.4 ± 20. 3） or tetralogy of Fallot （TOF, 75.6 ±23.2） were obviously lower than those with VSD （92.7 ± 18.8）. All differences showed statistical significance. Conclusions Neurocognition, specially motion development, of children is affected by CHD.