广西医学

目的比较深低温停循环（DHCA）和顺行脑灌注（ACP）两种灌注方法在新生儿主动脉缩窄矫治术中的有效性和安全性。方法纳入40例合并有血流动力学异常的心内畸形的主动脉缩窄新生儿作为研究对象，将其随机分为DHCA组（n=20）和ACP组（n=20），分别应用DHCA和ACP技术进行主动脉缩窄矫治术。比较两组患儿围术期（术前、术后第1天、术后第2天）的血清肌酐水平，以及术后急性肾损伤（AKI）和其他术后并发症的发生情况，对比两组的停循环或者脑灌注时间、主动脉阻断时间、体外循环持续时间、停循环期或脑灌注期间脑组织和肾脏组织血氧饱和度、术后AKI少尿期放置腹膜透析时间、术后呼吸机使用时间、心脏ICU（CICU）停留时间及总住院时间。结果术后住院期间复查超声心动图提示40例患儿心内畸形矫治满意，且无死亡病例。两组患儿血清肌酐水平有随时间延长而升高的趋势，而ACP组术后第1天及第2天的血肌酐水平低于DHCA组（P＜0.05）。所有患儿术后均出现AKI，但未发生神经系统损伤和不可逆性肾功能衰竭，两组其他术后并发症总发生率差异无统计学意义（P＞0.05）。两组停循环或者脑灌注时间差异无统计学意义（P＞0.05），而ACP组脑组织及肾脏组织血氧饱和度优于DHCA组，主动脉阻断时间、体外循环总时间、呼吸机使用时间、CICU停留时间、术后AKI少尿期放置腹膜透析时间及总住院时间短于DHCA组（P＜0.05）。结论对于合并有血流动力学异常的心内畸形的主动脉缩窄新生儿，相对于DHCA，ACP应用于主动脉缩窄矫治术可发挥更优的脑部和肾脏保护作用，可能更加安全、有效。

ObjectiveTo compare the effectiveness and safety between two perfusion methods of deep hypothermic circulatory arrest (DHCA) and anterograde cerebral perfusion (ACP) in neonatal repaired coarctation of aorta. MethodsA total of 40 neonates with coarctation of aorta of intracardiac malformation and concomitant hemodynamic abnormality were enrolled as the research subjects, and they were randomly assigned to DHCA group (n=20) or ACP group (n=20). DHCA and ACP techniques were applied to perform repaired coarctation of aorta, respectively. The level of serum creatinine during perioperative period (before operation, on the first day after operation, on the second day after operation), and postoperative acute kidney injury (AKI), the occurrence of other postoperative complications were compared between patients of the two groups. Time to circulatory arrest or cerebral perfusion, aortic cross clamp time, cardiopulmonary bypass duration, oxyhemoglobin saturation in brain and renal tissues during circulatory arrest period or cerebral perfusion period, postoperative AKI duration of peritoneal dialysis placement during oliguria period, postoperative ventilatory use time, length of cardiac ICU (CICU) stay, and total length of hospital stay were compared between patients of the two groups.ResultsEchocardiography during postoperative hospitalization indicated that 40 children with intracardiac malformation were successfully repaired, and no death occurred. Serum creatinine level of the two groups tended to elevate with time prolonging, and serum creatinine level of the ACP group was lower than that of the DHCA group on the first and second days after operation (P＜0.05). All children suffered from AKI after operation, but no nervous system injury and irreversible renal failure occurred. There was no statistically significant difference in the total incidence rate of other postoperative complications between the two groups (P＞0.05). There was no statistically significant difference in time to circulatory arrest or cerebral perfusion between the two groups (P＞0.05), whereas oxyhemoglobin saturation in brain and renal tissues of the ACP group was superior to that of the DHCA group, and the ACP group exhibited shorter aortic cross clamp time, cardiopulmonary bypass duration, ventilatory use time, length of CICU stay, postoperative AKI duration of peritoneal dialysis placement during oliguria period, and total length of hospital stay as compared with the DHCA group (P＜0.05). ConclusionFor neonates with coarctation of aorta of intracardiac malformation and concomitant hemodynamic abnormality, compared with DHCA, the application of ACP to repaired coarctation of aorta can exert superior protective effects of brain and kidney, which may be more safe and effective.

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