先天性心脏病患儿术后神经智力发育随访测试

Follow-up of neuropsychological development status in children after surgical treatment of congenital heart Diseases

目的:了解先天性心脏病患儿术后神经智力发育状况及影响神经智力发育的围术期危险因素。方法:对89例先天性心脏病术后门诊复查患儿及90例相同年龄段无心脏疾病正常儿童进行神经智力发育评估。将先天性心脏病患儿分为简单先天性心脏病组(RACHS-1评分≤2级)和复杂先天性心脏病组(RACHS-1评分≥3级),分组进行儿心量表各项目评估分析,并与正常儿童进行对比;分析患儿围术期参数与神经智力发育的相关性。结果:正常儿童神经智力发育情况优于整体先天性心脏病组患儿(P<0.05)。简单先天性心脏病组患儿发育商优于复杂先天性心脏病组患儿(P<0.05),与正常儿童发育商分布类似(P=0.420)。复杂先天性心脏病组患儿发育商值处于中等程度以下的比例高于简单先天性心脏病组患儿(P=0.032)和正常儿童(P<0.001)。多元回归分析提示,先天性心脏病患儿接受手术治疗时低月龄与神经智力发育落后相关性显著(P<0.05)。术前血浆尿素氮(BUN)降低、肌酐(Cr)升高以及术中体外循环(CPB)时间延长与神经智力发育落后存在相关性(P<0.05)。结论:复杂先天性心脏病组患儿存在明显神经智力发育落后。手术治疗时月龄、术前BUN值、术前Cr值以及术中CPB时间与先天性心脏病患儿远期神经智力发育具有相关性。

Objective： To assess neuropsychological development status in children after surgical treatment of congenital heart diseases（ CHDs） and analyze the risk factors. Methods： 89 children who received outpatient review in Fuwai Hospital from September 2015 to March 2016 after surgical treatment of CHDs were recruited in this study and 90 normal children without any CHDs were recruited as the control group. The children with CHDs were divided into simple CHDs group（ RACHS-1 score ≤ 2） and complex CHDs group（ RACHS-1 score ≥3） according to RACHS-1 classification. Neuropsychological development status was measured according to Pediatric-psychological mental test scale developed by Capital institute of pediatrics,Beijing and statistical analysis was compared. Results： The measurements of neuropsychological development showed the normal children behaved better than the children with CHDs（ P〈 0. 05）. The simple CHDs group achieved better distribution of development quotient than complex CHDs group（ P = 0. 032） and there was no difference between the normal control group and simple CHDs group（ P = 0. 420）. Multivariate regression analysis indicated that younger age at cardiac surgery,lower preoperative blood urea nitrogen（ BUN）,higher preoperative creatinine（ Cr） and prolonged duration of cardiopulmonary bypass（ CPB） accounted for lower scores in the test scale（ P〈 0. 05）. Conclusion： Distinct neuropsychological difficulties could be present especially in children with complex CHDs after surgical treatment. Younger age at cardiac surgery,preoperative BUN,Cr and CPB duration were perioperative factors that were associated with long-time neuropsychological development.