主动脉缩窄端侧吻合纠治术后的神经系统预后分析

doi:10.3969/j.issn.1674-8115.2025.06.010

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (6): 753-759.doi: 10.3969/j.issn.1674-8115.2025.06.010

主动脉缩窄端侧吻合纠治术后的神经系统预后分析

李卓杭¹, 于新迪¹, 任婧雅², 沈佳¹, 董素贞², 王伟¹()

^1.上海交通大学医学院附属上海儿童医学中心心胸外科，上海 200127
^2.上海交通大学医学院附属上海儿童医学中心放射科，上海 200127

收稿日期:2024-10-10 接受日期:2025-03-07 出版日期:2025-06-28 发布日期:2025-06-28
通讯作者: 王伟，主任医师，博士；电子信箱：wangwei@scmc.com.cn。
作者简介:李卓杭（2000—），男，硕士生；电子信箱：sss.sss@sjtu.edu.cn。
基金资助:
上海申康医院发展中心技术规范化管理和推广项目(SHDC22023228)

Postoperative neurodevelopmental outcomes of end-to-side anastomosis for coarctation of the aorta

LI Zhuohang¹, YU Xindi¹, REN Jingya², SHEN Jia¹, DONG Suzhen², WANG Wei¹()

^1.Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
^2.Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China

Received:2024-10-10 Accepted:2025-03-07 Online:2025-06-28 Published:2025-06-28
Contact: WANG Wei，E-mail:wangwei@scmc.com.cn.
Supported by:
Foundation of Shanghai Hospital Development Center(SHDC22023228)

摘要/Abstract

摘要：

目的·分析主动脉缩窄（coarctation of the aorta，CoA）端侧吻合纠治术后患儿的神经系统预后。方法·收集2017年1月1日至2021年12月31日于上海交通大学医学院附属上海儿童医学中心行CoA端侧吻合纠治术患儿的手术及神经系统随访资料，包括磁共振成像（magnetic resonance imaging，MRI）和Griffiths精神发育量表评分。根据Griffiths精神发育量表的分量表评分，评估患儿神经系统各方面预后情况。通过比较MRI和Griffiths精神发育量表评分结果正常与异常患儿的临床资料，分析2种检查结果之间的相关性，以及检查结果与患儿是否实施体外循环（cardiopulmonary bypass，CPB）及CPB方式的相关性。结果·纳入单纯或合并简单心内畸形的CoA患儿27例。有MRI检查结果者25例，其中检查结果异常者5例（20.0%）；有Griffiths精神发育量表评分者26例，其中评分异常的患儿21例（80.77%），包括听力-语言评分异常18例、表现评分异常12例。MRI和Griffiths精神发育量表检查结果异常与是否实施CPB无相关性（P=0.341，P=1.000）。MRI检查结果和Griffiths精神发育量表评分显示，在接受CPB的病例中，中低温组神经系统预后无异常的患儿占所有无异常者的比例较高，分别为80.00%与100.00%。结论·CoA端侧吻合纠治术后患儿发生神经系统异常的比例较高，其中影响较大的是听力-语言和表现能力；CPB不是直接引起神经系统预后不良的危险因素，在中低温下实施可能有利于保护神经系统。

关键词: 主动脉缩窄, 磁共振成像, 体外循环, 神经系统预后, Griffiths精神发育量表

Abstract:

Objective ·To analyze the neurodevelopmental outcomes of children after end-to-side anastomosis for coarctation of the aorta (CoA). Methods ·The surgical and neurological follow-up data were collected from children who underwent end-to-side anastomosis for CoA at Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine from January 1, 2017 to December 31, 2021. Neurological assessments included magnetic resonance imaging (MRI) and Griffiths Mental Development Scale assessments. Neurodevelopmental outcomes were evaluated using Griffiths Mental Development Scale. Clinical characteristics were compared between patients with normal and abnormal MRI and Griffiths Mental Development Scale results to assess the correlation between the two assessments and their association with cardiopulmonary bypass (CPB) use and CPB modality. Results ·Twenty-seven children with isolated CoA or CoA combined with simple intracardiac anomalies were included. MRI results were available for 25 cases, with 5 showing abnormalities (20.0%). Griffiths Mental Development Scale results were available for 26 cases, with 21 (80.77%) showing abnormal scores, including 18 in hearing and language, and 12 in performance. No significant correlation was found between abnormal MRI or Griffiths Mental Development Scale results and the use of CPB (P=0.341, P=1.000). Among patients who underwent CPB, those in the moderate hypothermia group accounted for the majority of cases without neurological abnormalities, with proportions of 80.00% (MRI) and 100.00% (Griffiths Mental Development Scale). Conclusion ·Children undergone end-to-side anastomosis for CoA are at relatively high risk for neurodevelopmental abnormalities, particularly in hearing-language and performance domains. CPB may not be a direct risk factor for poor neurodevelopmental outcome, and moderate hypothermia during CPB may be neuroprotective.

Key words: coarctation of the aorta (CoA), magnetic resonance imaging (MRI), cardiopulmonary bypass (CPB), neurodevelopmental outcome, Griffiths Mental Development Scale

中图分类号:

R726.1

李卓杭, 于新迪, 任婧雅, 沈佳, 董素贞, 王伟. 主动脉缩窄端侧吻合纠治术后的神经系统预后分析[J]. 上海交通大学学报（医学版）, 2025, 45(6): 753-759.

LI Zhuohang, YU Xindi, REN Jingya, SHEN Jia, DONG Suzhen, WANG Wei. Postoperative neurodevelopmental outcomes of end-to-side anastomosis for coarctation of the aorta[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(6): 753-759.

图/表 5

参考文献 14

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Item	All (n=27)	Non-CPB group (n=11)	CPB group (n=16)	t/z value	P value
Age at surgery /d	127.00 (32.00, 187.00)	127.00 (32.00, 187.00)	87.00 (21.25, 146.25)	-1.629	0.103
Weight at surgery/kg	5.000 (4.280, 6.800)	6.361±2.943	4.750 (4.145, 6.025)	-1.037	0.300
Age at examination /d	745.78±236.33	799.09±152.64	709.13±278.86	0.971	0.341
Surgery time/min	153.89±58.35	97.27±31.81	192.81±35.50	-7.160	<0.001
Number of cases with normal MRI results/n	20	10	10	‒	0.341
Number of cases with abnormal MRI results/n	5	1	4	‒	0.341
Number of cases with normal Griffiths Mental Development Scale results/n	5	2	3	‒	1.000
Number of cases with abnormal Griffiths Mental Development Scale results/n	21	8	13	‒	1.000

Item	All (n=27)	Non-CPB group (n=11)	CPB group (n=16)	t/z value	P value
Age at surgery /d	127.00 (32.00, 187.00)	127.00 (32.00, 187.00)	87.00 (21.25, 146.25)	-1.629	0.103
Weight at surgery/kg	5.000 (4.280, 6.800)	6.361±2.943	4.750 (4.145, 6.025)	-1.037	0.300
Age at examination /d	745.78±236.33	799.09±152.64	709.13±278.86	0.971	0.341
Surgery time/min	153.89±58.35	97.27±31.81	192.81±35.50	-7.160	<0.001
Number of cases with normal MRI results/n	20	10	10	‒	0.341
Number of cases with abnormal MRI results/n	5	1	4	‒	0.341
Number of cases with normal Griffiths Mental Development Scale results/n	5	2	3	‒	1.000
Number of cases with abnormal Griffiths Mental Development Scale results/n	21	8	13	‒	1.000

Item	All (n=25)	Abnormal MRI result group (n=5)	Normal MRI result group (n=20)	t/z value	P value
Age at surgery/d	127.00 (30.50, 190.50)	105.20±100.64	131.00 (38.50, 192.25)	-0.747	0.455
Weight at surgery/kg	5.000 (4.340, 6.750)	4.793±1.173	5.150 (4.310, 6.950)	-0.917	0.359
Age at examination /d	774.16±221.75	806.00±301.61	766.20±206.47	-0.352	0.728
Surgery time/min	148.40±57.13	156.00±40.68	146.50±61.28	-0.326	0.747
Number of cases with CPB/n	14	4	10
CPB time/min	96.29±30.77	69.75±22.60	106.90±27.55	2.378	0.035
HCT during CPB/%	24.71±2.16	24.75±2.06	24.70±2.31	-0.038	0.971
Number of cases with aortic cross-clamp/n	13	3	10
Aortic clamp time/min	56.23±16.70	44.67±13.32	59.70±16.57	1.425	0.182
Number of cases with circulatory arrest/n	5	1	4
Duration of circulatory arrest/min	24.80±6.42	21	25.75±6.99
Number of cases with cerebral perfusion/n	4	0	4
Duration of cerebral perfusion/min	30.00±6.58	‒	30.00±6.58

Item	All (n=25)	Abnormal MRI result group (n=5)	Normal MRI result group (n=20)	t/z value	P value
Age at surgery/d	127.00 (30.50, 190.50)	105.20±100.64	131.00 (38.50, 192.25)	-0.747	0.455
Weight at surgery/kg	5.000 (4.340, 6.750)	4.793±1.173	5.150 (4.310, 6.950)	-0.917	0.359
Age at examination /d	774.16±221.75	806.00±301.61	766.20±206.47	-0.352	0.728
Surgery time/min	148.40±57.13	156.00±40.68	146.50±61.28	-0.326	0.747
Number of cases with CPB/n	14	4	10
CPB time/min	96.29±30.77	69.75±22.60	106.90±27.55	2.378	0.035
HCT during CPB/%	24.71±2.16	24.75±2.06	24.70±2.31	-0.038	0.971
Number of cases with aortic cross-clamp/n	13	3	10
Aortic clamp time/min	56.23±16.70	44.67±13.32	59.70±16.57	1.425	0.182
Number of cases with circulatory arrest/n	5	1	4
Duration of circulatory arrest/min	24.80±6.42	21	25.75±6.99
Number of cases with cerebral perfusion/n	4	0	4
Duration of cerebral perfusion/min	30.00±6.58	‒	30.00±6.58

Item	All (n=26)	Abnormal Griffiths Mental Development Scale result group (n=21)	Normal Griffiths Mental Development Scale result group (n=5)	t/z value	P value
Age at surgery /d	116.00 (31.25, 188.75)	127.00 (34.00, 190.50)	119.40±125.23	-4.888	0.626
Weight at surgery/kg	5.000 (4.235, 6.850)	5.000 (4.250, 6.750)	6.008±2.822	0.000	1.000
Age at examination/d	737.12±236.60	741.33±253.17	719.40±170.06	-0.183	0.857
Surgery time/min	157.12±57.00	156.19±56.59	161.00±65.33	0.166	0.869
Number of cases with CPB/n	16	13	3
CPB time/min	99.00±30.16	93.46±28.35	123.00±30.61	1.608	0.130
HCT during CPB/%	24.56±2.13	24.46±2.22	25.00±2.00	0.384	0.707
Number of cases with aortic cross-clamp/n	15	12	3
Aortic clamp time/min	57.40±15.88	53.25±13.25	74.00±16.82	2.320	0.037
Number of cases with circulatory arrest/n	5	4	1
Duration of circulatory arrest/min	24.80±6.42	24.25±7.27	27.00
Number of cases with cerebral perfusion/n	6	5	1
Duration of cerebral perfusion/min	30.17±5.19	31.60±4.28	23.00

主动脉缩窄端侧吻合纠治术后的神经系统预后分析

Postoperative neurodevelopmental outcomes of end-to-side anastomosis for coarctation of the aorta

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Metrics

Item	Mild hypothermia group (n=3)	Moderate hypothermia group (n=10)	Deep Hypothermia group(n=3)	P value
Abnormal MRI results/n	3	0	1	0.006
Normal MRI results/n	0	8	2	0.006
Abnormal Griffiths Mental Development Scale results/n	3	7	3	0.518
Normal Griffiths Mental Development Scale results/n	0	3	0	0.518

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