Wong H R, Chundu K R
Division of Pediatric Medicine, Children's National Medical Center, Washington, DC.
Crit Care Med. 1993 Jun;21(6):884-7. doi: 10.1097/00003246-199306000-00017.
To define the frequency of metabolic alkalosis and its pathogenesis in children after open-heart surgery.
Retrospective chart review.
Multidisciplinary, tertiary, pediatric intensive care unit.
Fifty-six consecutive children undergoing open-heart surgery.
Metabolic alkalosis occurred in 29 (52%) of 56 patients. Seventy-two percent of patients < 12 months of age developed metabolic alkalosis as compared with 30% of patients > 12 months of age (p < .01 by chi-square). Patients developing metabolic alkalosis were younger, received more furosemide, had lower serum chloride concentrations, and underwent longer cardiopulmonary bypass times than nonmetabolic alkalosis patients. By stepwise multiple linear regression analysis, only age (p < .05) and serum chloride concentrations (p < .001) had independent correlations with the development of metabolic alkalosis; both variables had inverse correlations with arterial pH (r2 = .42). Patients with metabolic alkalosis also developed significantly (p < .01 by two tailed Student's t-test) lower serum ionized calcium concentrations (4.2 +/- 0.5 mg/dL [1.05 mmol/L]) as compared with nonmetabolic alkalosis patients (4.6 +/- 0.4 mg/dL [1.15 mmol/L]).
Postoperative metabolic alkalosis occurs frequently in children undergoing open-heart surgery. Chloride depletion seems to be the predominant factor in the pathogenesis of metabolic alkalosis. Younger age can serve as a positive predictor for the development of metabolic alkalosis in this subset of patients.
明确心脏直视手术后儿童代谢性碱中毒的发生率及其发病机制。
回顾性病历审查。
多学科、三级儿科重症监护病房。
56例连续接受心脏直视手术的儿童。
56例患者中有29例（52%）发生代谢性碱中毒。12个月以下的患者中有72%发生代谢性碱中毒，而12个月以上的患者中这一比例为30%（卡方检验，p <.01）。发生代谢性碱中毒的患者年龄更小，使用速尿更多，血清氯浓度更低，体外循环时间比未发生代谢性碱中毒的患者更长。通过逐步多元线性回归分析，只有年龄（p <.05）和血清氯浓度（p <.001）与代谢性碱中毒的发生独立相关；这两个变量与动脉血pH值呈负相关（r2 =.42）。与未发生代谢性碱中毒的患者相比，发生代谢性碱中毒的患者血清离子钙浓度也显著降低（双尾Student t检验，p <.01）（4.2 ± 0.5 mg/dL [1.05 mmol/L] 对比 4.6 ± 0.4 mg/dL [1.15 mmol/L]）。
心脏直视手术的儿童术后经常发生代谢性碱中毒。氯耗竭似乎是代谢性碱中毒发病机制中的主要因素。年龄较小可作为该组患者发生代谢性碱中毒的阳性预测指标。
