Perioperative balance between cerebral oxygen supply and utilization and cerebral activity in newborns with congenital heart disease
10.3760/cma.j.cn112434-20210114-00012
- VernacularTitle:先天性心脏病新生儿围手术期脑氧供需平衡与皮层脑功能研究
- Author:
Juan GUI
1
;
Yunxia SUN
;
Yumei LIU
;
Jin ZHONG
;
Yuhui YU
;
Jimei CHEN
Author Information
1. 广东省医学科学院 广东省人民医院新生儿重症监护室，广州 510080
- Keywords:
Heart surgery;
Congenital heart disease;
Newborn;
Cerebral oxygen supply and utilization;
Cerebral activity
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2022;38(1):38-43
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To determine the risk factors of perioperative cerebral oxygen supply and utilization and cerebral activity in newborns with congenital heart disease(CHD).Methods:In this prospective cohort study, NIRS and amplitude integrated EEG(aEEG) performed before and after surgery were used to assess cerebral oxygen supply and utilization and cerebral activity in these newborns. Cerebral tissue oxygenation index(TOI) and fractional tissue oxygen extraction(FTOE) measured from NIRS for each patient were compared to background pattern and SWC of aEEG before and after surgery. Analysis included clinical characteristics and explore the risk factors of TOI, FTOE.Results:90 CHD newborns were obtained. Pre- and postoperative TOI were 0.56±0.05 and 0.59±0.03, both of them were lower than the average for normal newborns( P<0.05). Pre- and postoperative FTOE were 0.36±0.07 and 0.39±0.04. TOI and FTOE were significantly improved after surgery( P<0.05). There was negative correlation between the TOI improvement after surgery and SpO 2 of right upper limb( β: -0.202). Patient with Respiratory support before surgery had lower preoperative TOI levels( β: -0.879). Preoperative SpO 2 was higher, then preoperative TOI was also higher( β: 0.214). The postoperative FTOE of who had lower amplitude showed by aEEG was significantly lower( P<0.05). The postoperative TOI of who had immature SWC was lower than mature SWC( P<0.05). Delayed chest closure was a risk factor for postoperative death. Conclusion:TOI in children with CHD improved significantly after operative, especially in patient with cyanosis CHD. Preoperative TOI is positively related to SpO 2. It’s positive correlation between cerebral activity and cerebral oxygen utilization. The patient who has immature SWC showed lower cerebral oxygen supply. Monitoring cerebral activity and oxygenation may be useful in perioperative management and cerebral protection of newborns with CHD.
