体外循环对先天性心脏病术后患儿脑认知功能的影响

先天性心脏病(CHD)是婴幼儿最常见的先天性畸形疾病。随着医疗水平显著提高,CHD患儿出生后的生存率明显提升。然而,CHD术后患儿诸多并发症又是另一种挑战,如心力衰竭、心律失常、肺动脉高压及脑认知功能发育障碍等,其中关于脑认知功能障碍的这一并发症逐渐得到广大学者的认识和重视。目前,已经通过细胞分子学方法、磁共振成像技术、光学成像技术、脑电活动监测技术及神经发育量表等研究方法来探索体外循环对CHD患儿脑认知功能的影响。患儿心脏术后会出现不同程度的脑认知功能障碍,这与体外循环相关的全身炎性反应、脑缺血再灌注损伤、体外循环时间、主动脉阻断时间、深低温停循环时间、温度的动态变化、血液稀释程度及血气管理策略等因素密切相关。现就体外循环对CHD术后患儿脑认知功能的影响进行综述,为临床诊疗提供参考,以改善CHD患儿的预后。

Influence of cardiopulmonary bypass on postoperative brain cognitive function of children with congenital heart disease

Congenital heart disease(CHD)is the most common congenital malformation disease in infants.With the rapid development of clinical treatment,the survival rate of children with CHD increased significantly.However,postoperative complications in children with CHD,including heart failure,heart arrythmia,pulmonary hypertension and brain cognitive dysfunction,are another challenge,among which,brain cognitive dysfunction has been gradually recognized and valued by scholars.At present,the effect of cardiopulmonary bypass on brain cognitive function of children with CHD has been studied by a variety of research methods,including molecular biological technique,magnetic resonance imaging technique,optical imaging technology,brain electrical activity monitoring technology and nervous development scale.Varying degrees of brain cognitive dysfunction will occur in children with CHD after heart surgery,which is closely associated with many factors such as systemic inflammatory response related to cardiopulmonary bypass,cerebral ischemia-reperfustion injury,the duration of cardiopulmonary bypass,aortic cross clamp time,deep hypothermia circulatory arrest time,dynamic changes of temperature,degree of hemodilution and blood gas management strategy.The influence of cardiopulmonary bypass on postoperative brain cognitive function in children with CHD is reviewed in this paper,in order to provide reference for clinical diagnosis and treatment,and to improve the prognosis of children with CHD.