目的:这项前瞻性队列研究旨在研究先天性心脏病患儿接受Glenn手术后颅内压(ICP)和脑血流动力学的变化,重点研究上腔静脉压与估计ICP的关系。
方法:单中心前瞻性队列研究。
方法:该研究在心脏中心进行了4年(2019-2022年)。
方法:本研究纳入了27例先天性心脏病患儿进行Glenn手术,并记录详细的患者人口统计学和主要诊断.
方法:在三个时间点进行经颅多普勒(TCD)超声检查:基线(术前),术后通气(24-48小时内),在出院时。TCD参数,血压,测量肺动脉压。
结果:TCD参数包括收缩期血流速度,舒张期血流速度(dFV),平均流速(mFV),搏动指数(PI),和阻力指数。使用已建立的公式计算估计的ICP和脑灌注压(CPP)。术后估计的ICP从11mmHg开始显着增加(四分位距[IQR],10-16mmHg)至15mmHg(IQR,12-21mmHg)术后(p=0.002),从22mmHg(IQR,14-30mmHg)至28mmHg(IQR,22-38mmHg)术后(p=0.1)。TCD指数反映了脑血流动力学的改变,包括dFV和mFV降低和PI升高。气道正压通气和拔管后的颅内血流动力学相似。
结论:Glenn程序显著增加了估计的ICP,同时显示出更高的CPP趋势。这些发现强调了接受Glenn手术的婴儿的静脉压和脑血流动力学之间的复杂相互作用。他们还强调了在这些情况下维持稳定的脑灌注的脑血管自动调节的显着复杂性。
OBJECTIVE: This prospective cohort study aimed to investigate changes in intracranial pressure (ICP) and cerebral hemodynamics in infants with congenital heart disease undergoing the Glenn procedure, focusing on the relationship between superior vena cava pressure and estimated ICP.
METHODS: A single-center prospective cohort study.
METHODS: The study was conducted in a cardiac center over 4 years (2019-2022).
METHODS: Twenty-seven infants with congenital heart disease scheduled for the Glenn procedure were included in the study, and detailed patient demographics and primary diagnoses were recorded.
METHODS: Transcranial Doppler (TCD) ultrasound examinations were performed at three time points: baseline (preoperatively), postoperative while ventilated (within 24-48 hr), and at discharge. TCD parameters, blood pressure, and pulmonary artery pressure were measured.
RESULTS: TCD parameters included systolic flow velocity, diastolic flow velocity (dFV), mean flow velocity (mFV), pulsatility index (PI), and resistance index. Estimated ICP and cerebral perfusion pressure (CPP) were calculated using established formulas. There was a significant postoperative increase in estimated ICP from 11 mm Hg (interquartile range [IQR], 10-16 mm Hg) to 15 mm Hg (IQR, 12-21 mm Hg) postoperatively (p = 0.002) with a trend toward higher CPP from 22 mm Hg (IQR, 14-30 mm Hg) to 28 mm Hg (IQR, 22-38 mm Hg) postoperatively (p = 0.1). TCD indices reflected alterations in cerebral hemodynamics, including decreased dFV and mFV and increased PI. Intracranial hemodynamics while on positive airway pressure and after extubation were similar.
CONCLUSIONS: Glenn procedure substantially increases estimated ICP while showing a trend toward higher CPP. These findings underscore the intricate interaction between venous pressure and cerebral hemodynamics in infants undergoing the Glenn procedure. They also highlight the remarkable complexity of cerebrovascular autoregulation in maintaining stable brain perfusion under these circumstances.