Yamada Tatsuya, Ochiai Ryoichi, Takeda Junzo, Kikuchi Haruhito, Ishibashi Midori, Watanabe Kiyoaki
Department of Anesthesiology, School of Medicine, Keio University, 35 Shinanoma-chi, Shinjuku-hu, Tokyo, Japan.
J Cardiothorac Vasc Anesth. 2005 Oct;19(5):603-7. doi: 10.1053/j.jvca.2005.02.004.
Cardiopulmonary bypass (CPB) affects hepatocellular integrity and occasionally results in liver dysfunction after cardiac surgery. Performing coronary artery bypass graft surgery without CPB may help to reduce the risk of this complication and better preserve perioperative liver function. This study compared perioperative hepatocellular damage in patients undergoing on-pump and off-pump bypass surgery.
Prospective study.
University hospital.
Patients scheduled for elective on-pump (n = 21) and off-pump (n = 17) coronary artery bypass surgery.
Liver function was assessed by serum levels of alcohol dehydrogenase (AD) and alpha-glutathione S-transferase (alpha-GST), which serve as more sensitive indices of hepatocellular injury than do conventional transaminases. Arterial blood was sampled at 6 stages: after induction of anesthesia (baseline); at the end of CPB in the on-pump group or on completion of the last distal anastomosis in the off-pump group; at the end of surgery; and 6 hours, 12 hours, and 24 hours after the end of anesthesia. The off-pump patients showed significantly lower increases in serum AD and alpha-GST levels than did the on-pump group. AD and alpha-GST values increased in the on-pump patients after the initiation of CPB and peaked at the end of surgery, with a return to baseline at 12 hours and 24 hours after the end of anesthesia. No clinically relevant liver dysfunction was observed in either group.
CPB induced transient subclinical hepatocellular damage, whereas off-pump revascularization attenuated this damage.
体外循环（CPB）会影响肝细胞完整性，心脏手术后偶尔会导致肝功能障碍。不使用CPB进行冠状动脉旁路移植手术可能有助于降低这种并发症的风险，并更好地保护围手术期肝功能。本研究比较了接受体外循环和非体外循环旁路手术患者的围手术期肝细胞损伤情况。
前瞻性研究。
大学医院。
计划进行择期体外循环（n = 21）和非体外循环（n = 17）冠状动脉旁路手术的患者。
通过血清乙醇脱氢酶（AD）和α-谷胱甘肽S-转移酶（α-GST）水平评估肝功能，与传统转氨酶相比，它们是更敏感的肝细胞损伤指标。在6个阶段采集动脉血：麻醉诱导后（基线）；体外循环组在CPB结束时或非体外循环组在最后一个远端吻合完成时；手术结束时；以及麻醉结束后6小时、12小时和24小时。非体外循环患者血清AD和α-GST水平的升高明显低于体外循环组。体外循环患者在CPB开始后AD和α-GST值升高，并在手术结束时达到峰值，在麻醉结束后12小时和24小时恢复至基线水平。两组均未观察到具有临床意义的肝功能障碍。
CPB诱导短暂的亚临床肝细胞损伤，而非体外循环血管重建减轻了这种损伤。
