右房布雷施奈德组氨酸-色氨酸-酮戊二酸心脏停搏液的清除：对儿科心脏手术患者低钠血症和癫痫发作的影响。

Scavenging right atrial Bretschneider histidine-tryptophan-ketoglutarate cardioplegia: Impact on hyponatremia and seizures in pediatric cardiac surgery patients.

机构信息

Division of Pediatric Cardiothoracic Surgery, The Pediatric Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, Fla.

出版信息

J Thorac Cardiovasc Surg. 2021 Jul;162(1):228-237. doi: 10.1016/j.jtcvs.2020.08.098. Epub 2020 Sep 4.

DOI:10.1016/j.jtcvs.2020.08.098

PMID:33036746

Abstract

OBJECTIVE

Custodiol-HTK cardioplegia (Custodiol-HTK Koheler Chemie, GmbH, Bensheim, Germany) causes fluctuations in serum sodium levels, hyponatremia, and is associated with postoperative seizures. We investigated the influence of scavenging right atrial effluent during delivery on intraoperative serum sodium levels and postoperative seizure incidence in pediatric cardiac surgery patients.

METHODS

A total of 204 patients younger than age 18 years undergoing congenital heart surgery between January 2016 and March 2018 were analyzed retrospectively. Serum sodium levels after administration of Custodiol-HTK cardioplegia were compared between the scavenge and nonscavenge groups and then in the propensity score-matched cohort (n = 96). Postoperative seizures were documented clinically and with electroencephalogram findings. Logistic regression models were used to identify the independent predictors of serum sodium level after aortic crossclamp.

RESULTS

Of 204 patients, 156 (76.5%) were in the nonscavenge, and 48 (23.5%) in the scavenge groups. A serum sodium level <130 mEq/L after crossclamp and administration of Custodiol-HTK cardioplegia in the nonscavenge group were 70% versus 21% in the scavenge group (odds ratio, 8.8; 95% confidence interval, 4.1-18.3; P < .0001) in the entire cohort, and 77% versus 21% (odds ratio, 12.8; 95% confidence interval, 4.8-33.1; P < .0001) in the propensity score-matched cohort. Of 16 patients experiencing a postoperative seizure, 14 (87.5%) had a sodium level <130 mEq/L and 2 (12.5%) had a sodium level ≥130 mEq/L (odds ratio, 5.1; 95% confidence interval, 1.3-22.8; P = .021) after crossclamp. Postoperative seizures occurred in the nonscavenge group but not the scavenge group in the entire cohort (P = .02) and in the propensity score-matched patients (P = .041). Multivariable analysis of the entire cohort showed that scavenge intervention was an independent factor associated with significantly decreased risk of sodium level <130 mEq/L (odds ratio, 0.17; 95% confidence interval, 0.08-0.36; P = .000).

CONCLUSIONS

Right atrial effluent scavenging was protective against fluctuations in serum sodium levels after crossclamp and Custodiol-HTK cardioplegia administration independently in both entire and matched cohort, and was also associated with decreased incidence of postoperative seizures.

摘要

目的

Custodiol-HTK 心脏停搏液（Custodiol-HTK Koheler Chemie，GmbH，德国本斯海姆）会导致血清钠水平波动、低钠血症，并与术后癫痫发作有关。我们研究了在儿科心脏手术中，在递送过程中清除右心房流出物对术中血清钠水平和术后癫痫发作发生率的影响。

方法

回顾性分析了 2016 年 1 月至 2018 年 3 月期间接受先天性心脏病手术的 204 名年龄小于 18 岁的患者。比较了 Custodiol-HTK 心脏停搏液给药后血清钠水平在清除组和非清除组之间，然后在倾向评分匹配队列中（n=96）。术后癫痫发作通过临床和脑电图发现进行记录。使用逻辑回归模型确定主动脉阻断后血清钠水平的独立预测因子。

结果

在 204 名患者中，156 名（76.5%）在非清除组，48 名（23.5%）在清除组。非清除组中，主动脉阻断和 Custodiol-HTK 心脏停搏液给药后血清钠水平<130 mEq/L 的比例为 70%，而清除组为 21%（比值比，8.8；95%置信区间，4.1-18.3；P<0.0001），在倾向评分匹配队列中，该比例为 77%对 21%（比值比，12.8；95%置信区间，4.8-33.1；P<0.0001）。在 16 名出现术后癫痫发作的患者中，14 名（87.5%）血清钠水平<130 mEq/L，2 名（12.5%）血清钠水平≥130 mEq/L（比值比，5.1；95%置信区间，1.3-22.8；P=0.021）。术后癫痫发作发生在非清除组，而不是清除组，无论是在整个队列（P=0.02）还是在倾向评分匹配的患者中（P=0.041）。整个队列的多变量分析表明，清除干预是与血清钠水平<130 mEq/L显著降低相关的独立因素（比值比，0.17；95%置信区间，0.08-0.36；P=0.000）。