≤1岁先天性心脏病患儿体外循环术后脑氧去饱和事件危险因素分析

doi:10.12372/jcp.2024.24e0252

Abstract

Abstract:

Objective To investigate the incidence of cerebral oxygen desaturation events (CDEs) and its related risk factors in infants under 1 year old with congenital heart disease (CHD) after surgery. Methods The clinical data of infants under 1 year old with CHD who underwent cardiopulmonary bypass surgery between January and June 2023 were retrospectively analyzed. According to whether CDEs occurred after surgery, the patients were divided into CDEs group and non-CDEs group. The clinical characteristics of the two groups were compared, and the influencing factors related to CDEs occurrence were analyzed. Results Among 397 infants who underwent CHD surgery, 67 infants (16.9%) developed CDEs after surgery, including 39 boys and 28 girls, with a median age of 4.0 (3.1-5.6) months. There were 330 patients (83.1%) without CDEs, 177 boys and 153 girls, with a median age of 4.5 (3.2-7.7) months. Binary logistic regression analysis showed that higher postoperative pulse oxygen saturation (SpO₂) and higher intraoperative hematocrit (Hct) were independent protective factors for CDEs, while prolonged cardiopulmonary bypass time and moderate to deep hypothermic circulatory arrest were independent risk factors for CDEs (P<0.05). ROC curve analysis showed that postoperative SpO₂, intraoperative Hct, and cardiopulmonary bypass time all had certain predictive value for the occurrence of CDEs (AUC>0.6, P<0.05). Conclusions The incidence of postoperative CDEs in CHD infants under 1 year old is higher. Postoperative SpO₂, intraoperative Hct, duration of cardiopulmonary bypass and cardiopulmonary bypass regimen may predict the incidence of postoperative CDEs in CHD patients in this age group.

Key words: congenital heart disease, cardiopulmonary bypass, cerebral protection

WANG Siyuan, CHEN Yu, SUN Menglian, HE Xiaomin, HUANG Jianhu, SHEN Nanping. Risk factors of cerebral oxygen desaturation events after cardiopulmonary bypass in children with congenital heart disease under 1 year old[J].Journal of Clinical Pediatrics, 2024, 42(10): 843-848.

Figures/Tables 4

References 28

[1]	中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2021概要[J]. 中国循环杂志, 2022, 37(6): 553-578.
[2]	Butler SC, Sadhwani A, Stopp C, et al. Neurodevelopmental assessment of infants with congenital heart disease in the early postoperative period[J]. Congenit Heart Dis, 2019, 14(2): 236-245. doi: 10.1111/chd.12686 pmid: 30324749
[3]	Trivedi A, Browning Carmo K, Jatana V, et al. Growth and risk of adverse neuro-developmental outcome in infants with congenital heart disease: a systematic review[J]. Acta Paediatr, 2023, 112(1): 53-62.
[4]	Chiong XH, Wong ZZ, Lim SM, et al. The use of cerebral oximetry in cardiac surgery: a systematic review and meta-analysis of randomized controlled trials[J]. Ann Card Anaesth, 2022, 25(4): 384-398. doi: 10.4103/aca.aca_149_21 pmid: 36254901
[5]	高华炜, 陈求名, 赵韡, 等. 三种先天性心脏病手术风险评分系统预测效能的比较[J]. 中华心血管病杂志, 2019, 47(5): 388-392.
[6]	胡洁, 白洁. ASA-PS分级及其他术前评估系统在儿科麻醉实践中的争鸣[J]. 国际麻醉学与复苏杂志, 2020, 41(10): 986-990.
[7]	Zhu S, Sai X, Lin J, et al. Mechanisms of perioperative brain damage in children with congenital heart disease[J]. Biomed Pharmacother, 2020, 132: 110957. doi: 10.1016/j.biopha.2020.110957 pmid: 33254442
[8]	包萌萌, 吴安石. 围术期脑电及脑氧饱和度监测的研究进展[J]. 中华麻醉学杂志, 2022, 42(3): 379-384.
[9]	Lynch JM, Mavroudis CD, Ko TS, et al. Association of ongoing cerebral oxygen extraction during deep hypothermic circulatory arrest with postoperative brain injury[J]. Semin Thorac Cardiovasc Surg, 2022, 34(4): 1275-1284.
[10]	Tsaousi G, Tramontana A, Yamani F, et al. Cerebral perfusion and brain oxygen saturation monitoring with: jugular venous oxygen saturation, cerebral oximetry, and transcranial Doppler ultrasonography[J]. Anesthesiol Clin, 2021, 39(3): 507-523. doi: 10.1016/j.anclin.2021.03.009 pmid: 34392882
[11]	Yu P, Esangbedo I, Li X, et al. Early changes in near-infrared spectroscopy are associated with cardiac arrest in children with congenital heart disease[J]. Front Pediatr, 2022, 10: 894125.
[12]	Ali J, Cody J, Maldonado Y, et al. Near-infrared spec-troscopy (NIRS) for cerebral and tissue oximetry: analysis of evolving applications[J]. J Cardiothorac Vasc Anesth, 2022, 36(8 Pt A): 2758-2766.
[13]	Gude P, Weber TP, Dazert S, et al. Comparison of cerebral oxygen desaturation events between children under general anesthesia and chloral hydrate sedation - a randomized controlled trial[J]. BMC Pediatr, 2022, 22(1): 720. doi: 10.1186/s12887-022-03739-8 pmid: 36529729
[14]	Jock A, Neunhoeffer F, Rörden A, et al. The effect of intraoperative cerebral oxygen desaturations on postoperative cerebral oxygen metabolism in neonates and infants a pilot study[J]. Paediatr Anaesth, 2024, 34(2): 138-144.
[15]	Chung CKE, Poon CCM, Irwin MG. Peri-operative neurological monitoring with electroencephalography and cerebral oximetry: a narrative review[J]. Anaesthesia, 2022, 77 Suppl 1: 113-122. doi: 10.1111/anae.15616 pmid: 35001382
[16]	Raghunathan K, Kerr D, Xian Y, et al. Cerebral oximetry during adult cardiac surgery is associated with improved postoperative outcomes[J]. J Cardiothorac Vasc Anesth, 2022, 36(9): 3529-3542. doi: 10.1053/j.jvca.2022.04.022 pmid: 35691854
[17]	Roberts ML, Lin HM, Tinuoye E, et al. The association of cerebral desaturation during one-lung ventilation and postoperative recovery: a prospective observational cohort study[J]. J Cardiothorac Vasc Anesth, 2021, 35(2): 542-550. doi: 10.1053/j.jvca.2020.07.065 pmid: 32861541
[18]	Stanley ME, Sellke FW. Neurocognitive decline in cardiac surgery patients: What do we know?[J]. J Thorac Cardiovasc Surg, 2023, 166(2): 543-552.
[19]	中国生物医学工程学会体外循环分会,中华医学会胸心血管外科学分会, 中国医师协会心血管外科医师分会. 中国体外循环专业技术标准(2021版)[J]. 中国体外循环杂志, 2021, 19(2): 67-72.
[20]	丁文祥, 苏肇伉, 朱德明, 等. 小儿体外循环学[M]. 上海: 世界图书出版公司, 2009.
[21]	McPhillips L, Kholwadwala D, Sison CP, et al. A novel brain injury biomarker correlates with cyanosis in infants with congenital heart disease[J]. Pediatr Cardiol, 2019, 40(3): 546-553. doi: 10.1007/s00246-018-2023-4 pmid: 30430186
[22]	Morey M, O'Gaora P, Pandit A, et al. Hyperglycemia acts in synergy with hypoxia to maintain the pro-inflammatory phenotype of macrophages[J]. PLoS One, 2019, 14(8): e0220577.
[23]	张桦, 文霜, 闵佳, 等. 微栓子与心脏手术围手术期神经认知障碍[J]. 南昌大学学报(医学版), 2022, 62(5): 85-89.
[24]	中国研究型医院学会神经再生与修复专业委员会心脏重症脑保护学组, 中国研究型医院学会神经再生与修复专业委员会神经重症护理与康复学组. 亚低温脑保护中国专家共识[J]. 中华危重病急救医学, 2020, 32(4): 385-391.
[25]	吕喆, 张义和, 赵荣. 深低温停循环发展历史与脑保护策略研究进展[J]. 中国体外循环杂志, 2024, 22(1):76-80.
[26]	Tan SZ, Singh S, Austin NJ, et al. Duration of deep hypothermic circulatory arrest for aortic arch surgery: is it a myth, fiction, or scientific leap?[J]. J Cardiovasc Surg (Torino), 2022, 63(3): 243-253.
[27]	韩宏光. 心脏外科围手术期脑保护中国专家共识(2019)[J]. 中华危重病急救医学, 2019, 31(2): 129-134.
[28]	Patel V, Orozco-Sevilla V, Coselli JS. Cerebral protection in aortic arch surgery: systematic review and meta-analysis[J]. Interact Cardiovasc Thorac Surg, 2022, 35(6): ivac270.

项目	未发生CDEs组(n=330)	发生CDEs组(n=67)	统计量	P
年龄[M(P₂₅~P₇₅)]/月	4.5(3.2~7.7)	4.0(3.1~5.6)	Z=2.68	0.007
男[n(%)]	177(53.6)	39(58.2)	χ²=0.47	0.493
体重($\bar{x}±s$)/kg	6.5±2.1	5.7±1.7	t=2.89	0.004
身高($\bar{x}±s$)/cm	63.5±7.1	59.5±7.9	t=4.14	<0.001
体表面积($\bar{x}±s$)/m²	0.34±0.06	0.30±0.06	t=3.53	<0.001
早产儿[n(%)]	23(7.0)	5(7.5)	χ²=0.00	1.000
ABC评分[M(P₂₅~P₇₅)]/分	6.5(5.5~7.5)	7.5(6.5~9.5)	Z=4.42	<0.001
ASA分级[n(%)]			－	0.740¹⁾
1级	0(0.0)	0(0.0)
2级	3(0.9)	0(0.0)
3级	287(83.9)	57(85.1)
4级	40(15.2)	10(14.9)
手术体位[n(%)]			χ²=9.91	0.002
正卧位	297(90.0)	51(76.1)
侧卧位	33(10.0)	16(23.9)
体外循环方案[n(%)]			χ²=23.07	<0.001
常温、浅低温	301(91.2)	48(71.6)
中、深低温	29(8.8)	19(28.4)
术中进行≥2次阻断[n(%)]	4(1.2)	5(7.5)	χ²=9.82	0.009
术前SBP($\bar{x}±s$)/mmHg	85.5±16.5	81.5±16.6	t=0.75	0.454
术前DBP($\bar{x}±s$)/mmHg	59.6±15.3	59.6±13.4	t=0.01	0.994
术前SpO₂($\bar{x}±s$)/%	97.5±1.7	97.4±1.5	t=0.49	0.624
术前心率($\bar{x}±s$)/次·min^-1	125.5±19.5	125.9±19.6	t=1.68	0.093
术前Hct($\bar{x}±s$)/%	30.7±3.9	27.9±4.2	t=5.24	<0.001
术前CrSO₂($\bar{x}±s$)/%	70.3±8.3	66.8±9.1	t=0.94	0.355
术后SBP($\bar{x}±s$)/mmHg	83.4±16.5	82.7±16.6	t=0.31	0.753
术后DBP($\bar{x}±s$)/mmHg	52.4±8.6	50.3±8.5	t=1.85	0.066
术后SpO₂[M(P₂₅~P₇₅)]/%	100.0(98.0~100.0)	98.0(85.0~99.0)	Z=3.24	0.001
术后心率($\bar{x}±s$)/次·min^-1	132.8±17.7	139.9±18.6	t=2.98	0.003
术中Hct($\bar{x}±s$)/%	26.6±2.5	24.3±1.7	t=7.44	<0.001
手术时间[M(P₂₅~P₇₅)]/min	157.0(140.0~179.0)	184.0(158.0~213.0)	Z=5.05	<0.001
术中阻断时间[M(P₂₅~P₇₅)]/min	35.0(26.0~47.8)	46.0(34.0~66.5)	Z=4.22	<0.001
体外循环时间[M(P₂₅~P₇₅)]/min	65.0(51.0~87.0)	90.0(67.0~120.0)	Z=5.18	<0.001

因素	偏回归系数	标准误	χ²值	P	OR(95%CI)
术后SpO₂	－0.29	0.08	13.40	<0.001	0.75(0.64~0.88)
术中Hct	－0.10	0.04	6.30	0.012	0.90(0.83~0.98)
体外循环时间	0.01	0.01	3.98	0.046	1.01(1.00~1.02)
体外循环方案为中、深低温	1.48	0.25	34.40	<0.001	4.41(2.68~7.23)
常量	22.13	7.74	8.19	0.040	－

因素	最佳阈值	AUC(95%CI)	P	灵敏度/%	特异度/%	约登指数
术后SpO₂/%	96	0.66(0.58~0.75)	0.003	23.9	96.7	0.22
术中Hct/%	25	0.76(0.69~0.82)	<0.001	50.7	78.8	0.30
体外循环时间/min	80	0.70(0.63~0.77)	<0.001	62.7	69.4	0.32
联合预测因子	0.18	0.82(0.76~0.88)	<0.001	73.1	80.0	0.53

Risk factors of cerebral oxygen desaturation events after cardiopulmonary bypass in children with congenital heart disease under 1 year old

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