应用aEEG评估危重先天性心脏病婴儿术后脑功能的研究

Postoperative brain functions in infants with critical congenital heart disease via aEEG

目的分析术后振幅整合脑电图（aEEG）结果与临床特征的相关性，研究危重先天性心脏病（CCHD）小婴儿心脏手术后脑功能的状况及其影响因素。方法选取我院NICU住院的确诊CCHD且早期接受手术治疗后的小婴儿（≤3个月）。利用脑功能监护仪监测并分析术后aEEG，比较其与临床特征的关系。结果共纳入226例，完成术后aEEG监测，约5．8％显示背景模式为轻度异常，0．9％显示为重度异常，27．4％的病例睡眠觉醒周期（SWC）不成熟，3．5％缺乏SWC。出生有缺氧史、存在延迟关胸、术后存在严重神经系统症状的病例术后SWC异常的可能性更大。围手术期惊厥活动少见，均为复杂型先心病。结论出生胎龄和出生缺氧病史是脑功能的影响因素。延迟关胸、术后严重感染／败血症及术后出现神经系统症状是术后出现脑损伤的危险因素。加强术后神经系统监测、控制术后严重感染，可明显改善CCHD新生儿及小婴儿术后脑功能。

Objective To explore the correlation between amplitude-integrated electroencephalographic （aEEG） findings and clinical features and to investigate the status of perioperative brain function in infants with critical congenital heart disease （CCHD） and its influencing factors. Methods Newborns and infants with critical CHD who were admitted to the NICU at our hospital were included. Postoperative aEEG was continuously monitored and analyzed, and its correlation with clinical condi- tions was compared. Results A total of 226 patients were enrolled. Of the 226 patients who underwent postoperative aEEG monitoring, approximately 5.8% showed mild abnormal background patterns, 0.9% showed severe abnormalities, 27.4% demonstrated an immature SWC, and 3.5% lacked SWC. The patients who had a history of hypoxia at birth exhibited delayed sternal closure or showed severe postoperative neurological symptoms and had higher probabilities of postoperative SWC abnor- malities. Several infants, all with complex CHD, had postoperative seizures. Conclusion Gestational age and oxygen defi- ciency at birth were the risk factors of brain injury. Delayed sternal closure, severe postoperative infection, and postoperative neurological symptoms were risk factors for postoperative brain injury. Postoperative nervous system monitoring and prevention postoperative severe infection may obviously improve the brain function of neonates and small infants with critical congenital heart disease.