CPB下心脏手术患儿术后中枢神经系统并发症发生的危险因素:近红外光谱法测定rSO_(2)C

Risk factors for postoperative central nervous system complications developed in pediatric patients undergoing cardiac surgery under cardiopulmonary bypass: determination of rSO_(2)C by near-infrared spectroscopy

目的筛选体外循环(CPB)下心脏手术患儿术后中枢神经系统并发症(CNSC)发生的危险因素:近红外光谱法测定脑组织局部氧饱和度( rSO_(2)C )。方法收集2019年7月至2020年1月本院住院患有先天性心脏病择期行CPB下直视心内畸形矫治术患儿60例,性别不限,年龄6~36月,体重5~19 kg,ASA分级Ⅱ或Ⅲ级。术中以近红外光谱仪连续监测患儿双侧 rSO_(2)C 。分别于麻醉诱导后10 min、CPB开始即刻、CPB结束时、入ICU时、入ICU后4、8 h、术后1、2和3 d(T0~8)时抽取中心静脉血,测定血清S100β蛋白和神经元特异性烯醇化酶(NSE)浓度。术后12个月时采用儿童脑功能分类量表评分进行神经功能预后评估,根据是否发生CNSC分为CNSC组和非CNSC组,采用logistic回归分析方法筛选CPB下心脏手术患儿术后CNSC发生的危险因素。结果2例患儿排除本研究。18例患儿术后发生CNSC,发生率31.0%。与非CNSC组比较,CNSC组CPB过程中 rSO_(2)C 最小值降低,动脉-脑氧饱和度差(da- rSO_(2)C )最大值升高, rSO_(2)C 降低幅度>25%、 rSO_(2)C <40%和da- rSO_(2)C >50%持续时间延长,T2~T8时血清S100β蛋白和NSE浓度升高(P<0.05)。logistic回归分析结果显示:CPB过程中 rSO_(2)C 降低幅度>25%、 rSO_(2)C <40%和da- rSO_(2)C >50%持续时间延长是术后CNSC发生的危险因素。结论CPB过程中 rSO_(2)C 降低幅度>25%、 rSO_(2)C <40%和da- rSO_(2)C >50%持续时间延长是心脏手术患儿术后CNSC发生的危险因素。

Objective To identify the risk factors for postoperative central nervous system complications(CNSC)developed in pediatric patients undergoing cardiac surgery under cardiopulmonary bypass(CPB)through determining regional cerebral oxygen saturation( rSO_(2)C )by near-infrared spectroscopy.Methods A total of 60 pediatric patients with congenital heart disease undergoing elective orthodontic correction surgery under CPB,of American Society of Anesthesiologists physical statusⅡorⅢ,of both sexes,aged 6-36 months,weighing 5-19 kg,in our hospital from July 2019 to January 2020 were collected.Intraoperative bilateral rSO_(2)C was monitored continuously by near-infrared spectroscopy.Blood samples were taken from the central vein at 10 min after induction of anesthesia,immediately after CPB,at the end of CPB,on admission to ICU,at 4 and 8 h after entering ICU and at 1,2 and 3 days after surgery(T0-8)for determination of the concentrations of serum S100βprotein and neuron specific enolase(NSE).At 12 months after surgery,the Pediatric Cerebral Performance Category(PCPC)score was used to evaluate the prognosis of neurological function.The patients were divided into 2 groups according to whether CNSC occurred:CNSC group and non-CNSC group.Multivariate logistic regression analysis was used to identify the risk factors for development of postoperative CNSC in pediatric patients undergoing cardiac surgery under CPB.Results Two patients were excluded from the study.Eighteen cases developed postoperative CNSC,and the incidence was 31.0%.Compared with group non-CNSC,the minimal rSO2 was significantly decreased,the maximal difference between pulse oxygen saturation and rSO_(2)C (da- rSO_(2)C )was increased,duration of reduction in rSO2>25%during CPB,duration of rSO_(2)C <40%during CPB and duration of da- rSO_(2)C >50%during CPB were prolonged,and concentrations of serum S100βprotein and NSE were increased at T2-T8 in group CNSC(P<0.05).The results of logistic regression analysis showed that prolonged duration of reduction in rSO_(2)C >25%during CPB,prolonged duration of rSO_(2)C <40%during CPB and prolonged duration of da- rSO_(2)C >50%during CPB were risk factors for development of postoperative CNSC.Conclusion Prolonged duration of reduction in rSO_(2)C >25%during CPB,prolonged duration of rSO_(2)C <40%during CPB and prolonged duration of da- rSO_(2)C >50%during CPB are the risk factors for postoperative CNCS developed.