小儿心脏手术后神经系统并发症的探讨

目的 :探讨小儿心脏手术后神经系统并发症的危险因素及防治方法。方法 :统计心脏手术 6 10例 ,术后神经系统并发症的种类、发生率、死亡率与对照组比较 ,并对术后神经系统并发症作回顾分析。结果 :本组心脏手术后神经系统并发症的总发生率为 2 .4 % (14 / 6 10 ) ,其中脑血管损害 4例 ,缺氧性脑部损害 6例 ,癫痫 2例 ,其他 2例 ,神经系统并发症致死亡 1例 ,占全部术后死亡 5 .0 % (1/ 2 0 ) ;与对照组相比 ,并发症组心肌血流阻断时间、体外循环转流时间、术后早期血乳酸盐浓度明显高于对照组 (P <0 .0 5 )。结论 :小儿心脏手术后神经系统并发症以脑血管损害为主。缩短术中心肌血流阻断和体外循环时间、早期检测血乳酸盐浓度 ,可早期诊断和减少术后神经系统并发症的发生。

Study of Neurological Complication after Pediatric Cardiac Surgery

Objective: To assess prevention and treatment of neurological complications (NCs) in pediatric patients undergone cardiopulmonary bypass(CPB). Methods: The risk factors, morbidity and mortality of NCs after surgery of 610 cases were studied retrospectively for analysis of NC of pediatric open heart surgery. Results: Occurrence of postoperative NC was 2.4%(15/610), in which 4 cases of cerebrovascular damage, 6 cases of anoxic brain damage, 2 cases of epilepsy and 2 cases of other abnormalities. Mortality of NC group was 5%, and compared with that of control groups, aortic clamping time, CPB time and levels of serum lactate of NC group were much longer (P<0.01). Conclusion: The main neurological complications after CPB surgery are cerebrovascular damage, anoxic brain damage and epilepsy. The risk factors of postoperative neurological complications are more malformations, acidosis, increased lactate, longer aortic clamping time and CPB time during pediatric cardiac surgery.