电阻抗成像技术和水通道蛋白4在3岁以下主动脉缩窄手术患儿脑水肿监测中的应用

Application of electrical impedance tomography and aquaporin 4 for cerebral edema in patients who underwent surgery for aortic coarctation at age < 3 years

摘要:

目的：比较3岁以下主动脉缩窄手术行顺行性脑灌注（antegrade cerebral perfusion，ACP）时在不同温度下患儿脑水肿情况，评估电阻抗成像技术是否可以评估患儿脑水肿情况。方法：回顾性分析重庆医科大学附属儿童医院胸心外科2012年1月至2017年1月收治的60例3岁以下行主动脉缩窄合并心内畸形的手术患儿基本资料（如性别、年龄和体质量），根据停循环时的鼻咽温度分为深低温组（17.0 ℃～20.0 ℃）、中低温组（20.1 ℃～25.0 ℃）和浅低温组（25.1 ℃～30.0 ℃）。检测麻醉诱导后、ACP前、ACP结束时、体外循环（cardiopulmonary bypass，CPB）结束时、术后3 h、术后12 h和术后24 h ７个时间点血清水通道蛋白4（aquaporin 4，AQP4）的表达和脑电阻抗系数。收集同期20例在我院行干下型室间隔缺损修补术的患儿为对照组。结果：采用重复测量方差分析，不同组间同时间点采用简单效应分析的Sidak检验，顺行性脑灌注下深低温组患儿血清AQP4水平在ACP结束、CPB结束、术后3 h、术后12 h、术后24 h相对于中低温组、浅低温组、对照组均明显升高（F组别=160.755，P组别=0.000；F时间=283.208，P时间=0.000，F交互=19.859，P交互=0.000）；深低温组患儿脑电阻抗系数在CPB结束、术后3 h、术后12 h、术后24 h相对于中低温组、浅低温组和对照组均明显升高（F组别=55.243，P组别=0.000；F时间=90.805，P时间=0.000，F交互=10.743，P交互=0.000）。结论：3岁以下主动脉缩窄ACP时深低温组脑损伤可能高于中低温组、浅低温组和对照组，基于电阻抗成像技术的脑水肿监测仪可以判断患儿脑水肿情况。

Abstract:

Objective：To compare cerebral edema of antegrade cerebral perfusion（ACP） among different temperatures in patients who underwent surgery for aortic coarctation at age < 3 years，and to evaluate the feasibility of electrical impedance tomographic assessment of cerebral edema. Methods：We retrospectively analyzed the basic data（sex，age，and weight） of 60 patients who underwent aortic coarctation and intracardiac deformity within 3 years of age，between January 2012 and January 2017，in our hospital. According to the nasopharyngeal temperature at the time of stopping circulation，the patients were divided into the deep hypothermia（17.0 ℃-20.0 ℃），medium-low temperature（20.1 ℃-25.0 ℃），and shallow hypothermia groups（25.1 ℃-30.0 ℃）. In addition，serum aquaporin 4 expression level and brain electrical impedance coefficients（CEICs） were measured at seven time points（including the time after anesthesia induction，before ACP，at the end of ACP，at the end of cardiopulmonary bypass，and 3，12，24 hours after sur-gery）. Twenty patients with subarterial ventricular septal defect in our hospital during the same period were included as the control group. Results：Analysis of variance was used to analyze the whole set of data，and the Sidak test of simple effect analysis was used to analyze the difference between groups at the same time point. The serum AQP4 level was significantly higher in the deep hypothermic group than in the moderate hypothermic，mild hypothermic，and control groups at the end of ACP，the end of CPB，3 hours after surgery，12 hours after surgery，and 24 hours after surgery（Famong groups=160.755，Pamong groups=0.000；Ftimes=283.208，Ptimes=0.000；Finteractions=19.859，Pinteractions=0.000）. The CEIC level was significantly higher in the deep hypothermic group than in the moderate hypothermic，mild hypothermic，and control groups at the end of CPB，and 3，12，and 24 hours after surgery（Famong groups=55.243，Pamong groups=0.000；Ftimes=90.805，Ptimes=0.000；Finteractions=10.743，Pinteractions=0.000）. Conclusion：The cerebral injury in the deep hypothermia group during the antegrade cerebral perfusion of the aortic coarctation at age < 3 years may be higher than that in the moderate hypothermic，mild hypothermic，and control groups. Electrical impedance tomography can be used for assessing cerebral edema.