van Thiel Robert J, Koopman Sofie R, Takkenberg Johanna J M, Ten Harkel Arend Derk Jan, Bogers Ad J J C
Department of Cardiothoracic Surgery, Thoraxcenter, Bd 156, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
Eur J Cardiothorac Surg. 2005 Aug;28(2):229-33. doi: 10.1016/j.ejcts.2005.04.013.
To determine occurrence, causes and associated mortality of postoperative metabolic alkalosis in pediatric cardiac surgery.
We retrospectively analyzed clinical and biochemical variables of 186 consecutive cardiac operations other than ductal ligations on children less than 2 years old during the years 1999 and 2000. Metabolic alkalosis was defined as a pH>7.48 corrected for PCO2, with a base excess > or =5 on two or more consecutive measurements during an 8h period.
Median age was 15 weeks [range 2 days-95 weeks] and median weight 4.5 kg [range 2.1-15.7 kg]. In 157 cases, cardiopulmonary bypass was used. In 92 [49%] procedures, metabolic alkalosis occurred with the highest corrected pH 24.3h after operation. Multivariate regression analysis associated age [P<0.001], cardiopulmonary bypass [P<0.001] and preoperative ductal dependency [P=0.04] with postoperative metabolic alkalosis. Of the surgical procedures the arterial switch for transposition of the great arteries [n=19] was strongly associated with metabolic alkalosis [100%, P<0.001]. Hemodilution appeared to enhance the development of alkalosis: those who experienced alkalosis had been hemodiluted to a greater extent [P=0.007]. Nearly 95% of patients experienced some increase in bicarbonate, but patients with metabolic alkalosis experienced more than those without [5.9 versus 3.5 mmol/l, P<0.001]. There were four postoperative deaths, only one coincidental with metabolic alkalosis.
Metabolic alkalosis has a high incidence after pediatric cardiac surgery, strongly associated with younger age, cardiopulmonary bypass, preoperative ductal dependency and perioperative hemodilution. Early recognition allows for timely therapeutic intervention.
确定小儿心脏手术术后代谢性碱中毒的发生率、病因及相关死亡率。
我们回顾性分析了1999年和2000年期间186例年龄小于2岁儿童的非动脉导管结扎心脏手术的临床和生化变量。代谢性碱中毒定义为在8小时内连续两次或更多次测量时，经二氧化碳分压校正后的pH>7.48，碱剩余≥5。
中位年龄为15周[范围2天至95周]，中位体重4.5千克[范围2.1至15.7千克]。157例使用了体外循环。在92例（49%）手术中发生了代谢性碱中毒，术后校正pH最高值出现在术后24.3小时。多因素回归分析显示年龄（P<0.001）、体外循环（P<0.001）和术前动脉导管依赖（P=0.04）与术后代谢性碱中毒相关。在手术操作中，大动脉转位的动脉调转术（n=19）与代谢性碱中毒密切相关（100%，P<0.001）。血液稀释似乎会促进碱中毒的发生：发生碱中毒的患者血液稀释程度更大（P=0.007）。近95%的患者碳酸氢根有一定升高，但代谢性碱中毒患者升高幅度大于无碱中毒患者（5.9对3.5毫摩尔/升，P<0.001）。术后有4例死亡，仅1例与代谢性碱中毒同时发生。
小儿心脏手术后代谢性碱中毒发生率较高，与年龄较小、体外循环、术前动脉导管依赖及围手术期血液稀释密切相关。早期识别有助于及时进行治疗干预。
