RESUMO
Congenital heart disease (CHD) is the most common congenital malformation disease in infants.With the rapid development of clinical treatment, the survival rate of children with CHD increased significantly.However, postoperative complications in children with CHD, including heart failure, heart arrythmia, pulmonary hypertension and brain cognitive dysfunction, are another challenge, among which, brain cognitive dysfunction has been gradually recognized and valued by scholars.At present, the effect of cardiopulmonary bypass on brain cognitive function of children with CHD has been studied by a variety of research methods, including molecular biological technique, magnetic resonance imaging technique, optical imaging technology, brain electrical activity monitoring technology and nervous development scale.Varying degrees of brain cognitive dysfunction will occur in children with CHD after heart surgery, which is closely associated with many factors such as systemic inflammatory response related to cardiopulmonary bypass, cerebral ischemia-reperfustion injury, the duration of cardiopulmonary bypass, aortic cross clamp time, deep hypothermia circulatory arrest time, dynamic changes of temperature, degree of hemodilution and blood gas management strategy.The influence of cardiopulmonary bypass on postoperative brain cognitive function in children with CHD is reviewed in this paper, in order to provide reference for clinical diagnosis and treatment, and to improve the prognosis of children with CHD.
RESUMO
Objective To explore the effect of third ventriculostomy under neuroendoscopy in the treatment of children with obstructive hydrocephalus.Methods Thirty-eight cases of obstructive hydrocephalus treated at Zhumadian Central Hospital from January 2015 to December 2017 were selected,and among them there were 20 males and 18 females,aged ＜ 12 months in 4 cases,1-3 years in 17 cases and 3-6 years in 17 cases.The children were treated by third ventriculostomy under neuroendoscopy,the therapeutic effect was observed,and the brain cognitive function was evaluated by Gesell child intelligence development diagnostic scale.Results After treatment,81.58％ (31/38 cases) of children were improved,the conditions of 10.53％ (4/38 cases) of patients did not change,and 7.89％ (3/38 cases) of patients got aggravated.The development quotient(DQ) scores of 1 month,3 months and 6 months after operation were (57.20 ± 5.81) scores,(75.12 ± 6.02) scores and (80.43 ± 7.00) scores,respectively,which were significantly higher than those of the preoperative scores [(50.12 ± 6.11) scores] (t =6.933,8.192,10.033,all P ＜0.05),and the DQ scores at 6 months after operation were (80.43 ± 7.00),which were significantly higher than those of 1 month and 3 months after operation (t =5.192,7.022,all P ＜0.05).The width of ventricle frontal horn at 1,3 and 6 months after operation was (37.82 ± 6.01) mm,(38.00 ± 5.89) mm and (37.03 ± 5.25) mm,respectively,which was significantly lower than that of preoperative width [(44.01 ± 5.61) mm] (F =24.292,P ＜ 0.05).The width of third ventricle at 1,3 and 6 months after operation was (16.89 ± 3.82) mm,(16.72 ± 4.10) mm and (16.11 ± 4.11) mm,respectively,which was significantly lower than that of preoperative width [(21.02 ± 4.37)mm] (F =19.143,P ＜ 0.05).The levels of adrenomedullin and neuron specific enolase decreased significantly at 1 month,3 months and 6 months after operation (F =45.281,11.022,all P ＜ 0.05).No serious complications occurred.Conclusions Third ventriculostomy under neuroendoscopy is effective in treating obstructive hydrocephalus in children and may improve the cognitive function in children.