先天性心脏病患儿体外循环术后早期癫痫发作及影响因素的研究

目的:检查先天性心脏病(CHD)患儿体外循环(CPB)术后早期癫痫发作的情况，并探讨影响癫痫发作的因素。方法:纳入2018年5月至2019年4月入心脏重症监护室(CICU)的87例CPB术后患儿(年龄3 d～110个月，中位年龄4.4个月)，77例在术后72 h内行持续脑电图(EEG)及脑氧饱和度(ScO ...

Analysis of perioperative risk factors for seizures in children with congenital heart disease following cardiopulmonary bypass

Objective To examine the occurrence of seizures and perioperative risk factors in children after obtaining cardiopulmonary bypass(CPB).Methods Electroencephalograph(EEG)and cerebral oxygen saturation(ScO2)were monitored in 87 patients(aged 3 days-110 months,with the median at 4.4 months)and they were admitted to the Cardiac Intensive Care Unit(CICU)from May 2018 to April 2019,with 77 patients for 72 h after CPB and 10 cases with clinical seizures after CICU discharge for 8-180 h.Clinical data were recorded every 4 hours,including blood pressure,central venous pressure(CVP),temperature,arterial blood gases,lactate,doses of Dopamine,Milrinone,and Adrenalin,and daily C-reaction protein(CRP)and N-terminal pro-brain natriuretic peptide(NT-proBNP).Demographic data,the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery(STAT)mortality classification and clinical outcomes(duration of mechanical ventilation,CICU and hospital stay,and death)were recorded.Results Seizures occurred in 24 patients(27.6%)within 48 h after CPB.EEG seizures appeared in 7 patients,both EEG and clinical seizures in 7 patients,and clinical seizures in 10 patients.Three patients developed epilepsy.There were 2 hospital deaths and both had EEG seizures.Patients with seizures had higher STAT categories,longer operative time and worse clinical outcomes(all P<0.05).Univariate regression revealed that the occurrence of seizures was positively related to adrenalin,temperature,lactate level(all P<0.01),blood pressure,CVP(all P<0.05)and CRP(P<0.1),and negatively correlated with arterial carbon dioxide tension[pa(CO2)],ScO2 and dose of Milrinone(all P<0.05).In multivariate regression,only dose of Adrenalin(P<0.001)and lactate level(P<0.01)remained significant.Conclusions The incidence of seizures was high in children after CPB.Numerous perioperative factors that were related to seizures were identified.The most significant risk factors were higher dose of adrenaline and lactate level.Studies on neurological injury after CPB are urgently needed in China in order to reduce brain injury and improve neurodevelopmental outcomes.