The number of pediatric patients who survive open-heart surgery has increased in recent years and the complications seen in this patient group continue to decrease with each technological advance, including new surgical and neuroprotective techniques and the improvement in surgeons’ experience with this patient population. However, neurological complications, which are the most feared and difficult to manage, require long-term follow-up, and increase hospital costs remain a leading cause of mortality and morbidity in this cohort. We evaluated the neurological physical examination, cranial computed tomography (CT), and magnetic resonance (MRI) records of 162 pediatric patients with neurological symptoms lasting more than 24 h after undergoing heart surgery in our clinic between June 2012 and May 2020. The patients’ ages ranged from 0 to 205 months, with a mean of 60.59 ± 46.44 months. Of the 3849 pediatric cardiac surgery patients we screened, 162 had neurological complications in the early period (the first 10 days after surgery). The incidence was calculated as 4.2%; 69 patients (42.6%) experienced seizures, 17 (10.5%) experienced confusion, 39 (24.1%) had stupor, and 37 (22.8%) had hemiparesis. Of the patients who developed neurological complications, 54 (33.3%) died. Patients with neurological complications were divided into 3 groups: strokes (n = 90), intracranial bleeding (n = 37), and no radiological results (n = 35). Thirty-four patients (37.8%) in the stroke group died, as did 15 (40%) in the bleeding group, and 5 (14.3%) in the no radiological results group. Studies on neurological complications after pediatric heart surgery in the literature are currently insufficient. We think that this study will contribute to a more detailed discussion of the issue. Responses to neurological events and treatment in the pediatric group may differ compared to the adult age group. Primary prevention methods should be the main approach in combating neurological complications; their formation mechanisms should be carefully monitored and preventive treatment strategies should be developed.

中文翻译：

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小儿心脏手术后的神经系统并发症


近年来，心脏直视手术中幸存的儿科患者数量有所增加，并且随着技术的进步，包括新的手术和神经保护技术以及外科医生治疗该患者群体的经验的提高，该患者群体中出现的并发症持续减少。然而，最令人担心和难以管理的神经系统并发症需要长期随访，并且医院费用的增加仍然是该人群死亡和发病的主要原因。我们评估了 2012 年 6 月至 2020 年 5 月期间在我们诊所接受心脏手术后出现神经系统症状持续超过 24 小时的 162 例儿童患者的神经体格检查、颅脑计算机断层扫描 (CT) 和磁共振 (MRI) 记录。年龄范围为0至205个月，平均为60.59±46.44个月。在我们筛查的 3849 名小儿心脏手术患者中，有 162 名患者在早期（术后前 10 天）出现神经系统并发症。计算出发生率为4.2%； 69 例患者（42.6%）出现癫痫发作，17 例（10.5%）出现意识模糊，39 例（24.1%）出现昏迷，37 例（22.8%）出现偏瘫。在出现神经系统并发症的患者中，54 例（33.3%）死亡。患有神经系统并发症的患者被分为 3 组：中风（n = 90）、颅内出血（n = 37）和无放射学结果（n = 35）。中风组有 34 名患者（37.8%）死亡，出血组有 15 名患者（40%）死亡，无放射学结果组有 5 名患者（14.3%）死亡。目前文献中关于小儿心脏手术后神经系统并发症的研究还不够。我们认为这项研究将有助于对该问题进行更详细的讨论。 与成人年龄组相比，儿科组对神经系统事件和治疗的反应可能有所不同。一级预防方法应是对抗神经系统并发症的主要方法；应仔细监测其形成机制并制定预防性治疗策略。