- 作者：Paul P. Drury ; Alistair J. Gunn ; Laura Bennet ; Anusha Ganeshalingham ; Kirsten Finucane ; David Buckley ; John Beca
- 关键词：螖Hb ; difference in hemoglobin ; aEEG ; amplitude-integrated electroencephalography ; aEEGmin ; electroencephalographic minimum amplitude ; ASO ; arterial switch operation ; CHD ; congenital heart disease ; CPB ; cardiopulmonary bypass ; DHCA ; deep hypothermic circulatory arrest ; Hb ; deoxyhemoglobin ; Hbo2 ; oxyhemoglobin ; EEG ; electroencephalography ; FTOE ; fractional tissue oxygen extraction ; MAP ; mean arterial blood pressure ; MRI ; magnetic resonance imaging ; NIRS ; near-infrared spectroscopy ; Sao2 ; arterial
- 刊名：The Journal of Thoracic and Cardiovascular Surgery
- 出版年：December, 2013
- 年：2013
- 卷：146
- 期：6
- 页码：1327-1333
- 全文大小：356 K
Objective
Deep hypothermic circulatory arrest may be associated with increased neural injury. We investigated whether short periods of deep hypothermic circulatory arrest are associated with altered neurophysiologic recovery or greater risk of injury.Methods
Eighteen term infants with transposition of the great arteries undergoing the arterial switch operation were enrolled. Deep hypothermic circulatory arrest was used in 11, and bypass alone in 7. Near-infrared spectroscopy and amplitude-integrated electroencephalography were recorded with standard monitoring during and from 4 to 16 h after surgery. Fractional tissue oxygen extraction was determined from arterial oxygen saturation and venous weighted intracerebral oxygenation. Magnetic resonance imaging was performed before and 5 to 7 days after surgery.
Results
There were no significant differences between patients requiring deep hypothermic circulatory arrest (median, 5 min; range, 3-6 min) or cardiopulmonary bypass only at the beginning of surgery. At the end of surgery, amplitude-integrated electroencephalography minimum amplitude was significantly lower in the deep hypothermic circulatory arrest group (P聽<聽.05), and fractional tissue oxygen extraction tended to be lower (P聽=聽.068). After surgery, deep hypothermic circulatory arrest was associated with significantly higher tissue oxygenation index, lower fractional tissue oxygen extraction, and lower core temperature (P聽<聽.05). Magnetic resonance imaging-defined white matter injuries before and after surgery were similar between groups.
Conclusions
In this prospective, observational study, brief deep hypothermic circulatory arrest during arterial switch was associated with reduced cerebral oxygen uptake during recovery, with transient electroencephalographic suppression but no increase in risk of white matter injury.