影响体外循环前后儿童心肌地高辛含量的多因素分析

The multiple factor analysis on myocardial digoxin contents in children during cardiopulmonary bypass

目的 探讨体外循环前后的各种因素对儿童心肌地高辛含量的影响。方法 儿童先天性心脏病室间隔缺损肺高压病人，口服维持剂量地高辛１ 周以上，体外循环前后各取右心耳５０ ｍｇ 测量心肌地高辛含量，将可能影响心肌地高辛含量的各种因素进行多因素的逐步回归分析，其结果结合临床综合考虑，从而探讨影响心肌地高辛含量的诸因素。结果 术前心肌地高辛含量与病人术前肾功能（ＢＵＮ） 、血清总蛋白及术前血球压积、血红蛋白有关；体外循环结束时的心肌地高辛含量与术中的停跳液及预充液量、术前地高辛按体表面积计算的用药剂量、手术结束时的总蛋白、血液ｐＨ 值以及血清钠镁离子浓度有关。结论 影响小儿体外循环前后心肌地高辛含量的因素各有不同；术前主要与肾功能、血球压积及总蛋白有关，而停机时则与术前的用药时间、用药剂量有关外，还与术中影响心肌与地高辛结合的酸碱平衡及钠镁离子浓度及与是否造成心肌脱水因素的机器预充及停跳液量相关，在临床的用药过程中应综合考虑。

Objective To study all kinds of possible factors affecting the myocardial digoxin contents in children during cardiopulmonary bypass (CPB). Methods All congenital heart disease patients having ventricular septal defect associated with middle or severe degree of pulmonary hypertension were given maintaining dose of digoxin for over one week. Two 50 mg myocardial samples of right atrial appendage were obtained before and after CPB, then the digoxin contents were detected. Multiple factor progress regression analysis was used to find out all clinically related factors that affected the myocardial digoxin contents in children during CPB. Results The contents of digoxin before CPB were related with the levels of blood urea nitrogen and serum total protein, hematocrit and hemoglobin. The contents of digoxin right after CPB were associated with cardioplegia and prima amount, the dose of digoxin counted by the body surface area, and the duration of the digoxin used. They were also correlated with the serum total protein. Conclusion The myocardial digoxin contents before and after CPB were affected by various factors. They were mainly related to kidney function, levels of hematocrit and serum total protein before CPB. But after CPB they were related to the dose of digoxin counted by the body surface area and the duration of the digoxin used and total protein levels right after CPB. The balance of acid alkali and the concentrations of potassium and magnesium irons, which may affect the combination of digoxin with myocardium, also affected the myocardial digoxin contents. Also they were related to cardioplegia and prima amount whether they caused the myocardium dehydrated.