【罂粟摘要】小儿心脏手术中脑电图监测下体外循环并深低温停循环的应用：一项系统回顾及Meta分析
小儿心脏手术中脑电图监测下体外循环并深低温停循环的应用：一项系统回顾及Meta分析
贵州医科大学 高鸿教授课题组
翻译：吴学艳 编辑：佟睿 审校：曹莹
心脏手术修复先天性心脏病对小儿发育中的大脑造成特定损伤。体外循环并深低温停循环(DHCA)是先天性心脏病修补术中一种简单有效的减少手术视野出血方法。然而，也有人担心，长时间的DHCA会增加神经系统损伤的风险；脑电图(EEG)作为一种神经监测方法应用于成人，在较小程度上也应用于小儿心脏手术中。本研究旨在通过EEG监测评估儿童DHCA后的预后。
在此项系统回顾和Meta分析中，检索PubMed、Cochrane Central Register of Control Trials、Scopus、Institute of Science Index和Embase数据库中相关文章。在适当的情况下，采用固定或随机效应模型。
外科手术条件下。
儿科人群(≤18岁)。
DHCA(18°C)，EEG监测。
纳入19篇文章，涉及1,267名≤18岁的儿童患者。在接受DHCA治疗的患儿中,癫痫临床发作发生率为12.9%，EEG发作发生率为14.9%；死亡率为6.3%。DHCA持续时间越长，脑电图显示癫痫发作和神经系统异常的风险越高。此外，癫痫发作与神经系统异常风险越高和神经系统发育迟缓有关。
DHCA后EEG异常和神经系统功能异常较为常见；DHCA持续时间越长，脑电图癫痫发作及神经系统功能异常越多。此外，EEG癫痫发作比临床发作更为常见。癫痫发作被认为与神经系统异常增加及神经系统发育延迟有关。
Deep Hypothermic Circulatory Arrest in the Pediatric Population Undergoing Cardiac Surgery With Electroencephalography Monitoring: A Systematic Review and Meta-Analysis
Objective: Cardiac surgery for repair of congenital heart defects poses unique hazards to the developing brain. Deep hypothermic circulatory arrest (DHCA) is a simple and effective method for facilitating a bloodless surgical field during congenital heart defect repair. There are, however, some concerns that prolonged DHCA increases the risk of nervous system injury. The electroencephalogram (EEG) is used in adult and, to a lesser extent, pediatric cardiac procedures as a neuromonitoring method. The present study was performed to assess outcomes following DHCA with EEG monitoring in the pediatric population.
Design: In this systematic review and meta-analysis, the PubMed, Cochrane Central Register of Controlled Trials, Scopus, Institute of Science Index, and Embase databases were searched from inception for relevant articles. A fixed- or random-effects model, as appropriate, was used.
Setting: Surgical setting.
Participants: Pediatric population (≤18 y old).
Interventions: DHCA (18°C) with EEG monitoring.
Measurements and main results: Nineteen articles with 1,267 pediatric patients ≤18 years were included. The event rate of clinical and EEG seizures among patients who underwent DHCA was 12.9% and 14.9%, respectively. Mortality was found to have a 6.3% prevalence. A longer duration of DHCA was associated with a higher risk of EEG seizure and neurologic abnormalities. In addition, seizures were associated with increased neurologic abnormalities and neurodevelopmental delay.
Conclusions: EEG and neurologic abnormalities were common after DHCA. A longer duration of DHCA was found to lead to more EEG seizure and neurologic abnormalities. Moreover, EEG seizures were more common than clinical seizures. Seizures were found to be associated with increased neurologic abnormalities and neurodevelopmental delay.