小儿复杂先天性心脏病体外循环术后肌张力增高影响因素及防护对策

Influencing factors and protective countermeasures for increased muscle tension in children with complex congenital heart disease after undergoing cardiopulmonary bypass

目的探讨小儿复杂先天性心脏病(CCHD)体外循环术后肌张力增高的影响因素,并提出防护策略,减少肌张力增高现象发生。方法选取2017年3月—2020年1月符合纳入条件与排除条件的31例小儿CCHD患儿为研究对象,将其中13例术后肌张力增高的患儿作为病例组,18例未出现术后肌张力增高的患儿作为对照组。采用单因素分析、多因素Logistic回归分析确定患儿术后肌张力增高的发生原因,并讨论制定应对措施。结果单因素分析显示,肌张力增高的发生与术后血清游离钙值、输血量、磷酸肌酸钠用量相关性明显(P<0.05),与年龄、体质量、术前血清总钙水平及主动脉阻断时间等无明显的相关性(P>0.05)。多因素Logistic回归分析显示,术后血清游离钙值、输血量是导致肌张力增高的独立危险因素(P<0.05)。结论小儿CCHD体外循环手术后肌张力的增高与输血量、术后血清游离钙值相关性显著,积极的临床护理对减少肌张力增高的发生至关重要。

Objective To explore the influencing factors of increased muscle tension in children with complex congenital heart disease(CCHD)after undergoing cardiopulmonary bypass,and propose protective strategies to reduce the occurrence of increased muscle tension.Methods A total of 31 children with CCHD who met the inclusion and exclusion criteria were selected as the study objects.Among them,13 cases of children with postoperative hypertonia were selected as a case group,and the other 18 cases of children with no postoperative hypertonia were selected as a control group.Univariate analysis and multivariate logistic regression analysis were used to determine the cause of postoperative muscle tension increase in children,and to discuss the formulation of countermeasures.Results Univariate analysis showed that the occurrence of increased muscle tension was significantly correlated with postoperative serum free calcium value,blood transfusion volume,and sodium creatine phosphate dosage(P<0.05),but not signifi cantly correlated with age,body weight,preoperative serum total calcium level,and aortic occlusion time(P>0.05).Multivariate Logistic regression analysis showed that the postoperative serum free calcium value and blood transfusion were the independent risk factors leading to increased muscle tension(P<0.05).Conclusion There was a signifi cant correlation between the increase of muscular tension in children with CCHD after who underwent cardiopulmonary bypass with blood transfusion and postoperative serum free calcium value.Active clinical care was essential to reduce the occurrence of increased muscular tension.