An Yong, Xiao Ying-Bin, Zhong Qian-Jin
Department of Cardiovascular Surgery, Xin-Qiao Hospital, Third Military Medical University, Chongqing 400037, China.
World J Gastroenterol. 2006 Nov 7;12(41):6722-6. doi: 10.3748/wjg.v12.i41.6722.
To clarify the incidence and nature of postoperative hyperbilirubinemia in patients after modern extracorporeal circulation, to analyze possible perioperative risk factors, and to elucidate the clinical significance of postoperative hyperbilirubinemia associated mortality and morbidity.
Between March 2005 and May 2006, three hundred and eighty six consecutive patients undergoing extracorporeal circulation surgery due to a variety of cardiac lesions were investigated prospectively. The incidence of postoperative hyperbilirubinemia was defined as a serum total bilirubin concentration of more than 51 micromol/L. Several perioperative parameters were compared by logistic regression between hyperbilirubinemia and non-hyperbilirubinemia patients to determine possible risk factors contributing to postoperative hyperbilirubinemia and mortality.
Overall incidence of postoperative hyperbilirubinemia was 25.3% (98/386). In patients with postoperative hyperbilirubinemia, 56.2% reached peak total bilirubin concentration on the first postoperative day, 33.5% on the second day, and 10.3% on the seventh day. Eighty percent of the increase of total bilirubin resulted from an increase of both conjugated and unconjugated bilirubin. Development of postoperative hyperbilirubinemia was associated with a higher mortality (P<0.01), longer duration of mechanical ventilation (P<0.05) and longer ICU stay time (P<0.05). Preoperative total bilirubin concentration, preoperative right atrium pressure, numbers of valves replaced and of blood transfusion requirement were identified as important predictors for postoperative hyperbilirubinemia.
Early postoperative hyperbilirubinemia after modern extracorporeal circulation is mainly caused by an increase in both conjugated and unconjugated bilirubin, and is associated with a high mortality. Important contributing factors are the preoperative total bilirubin concentration, preoperative severity of right atrial pressure, numbers of valve replacement procedures, and the amount of blood transfusion requirement during and shortly after surgery. We suggest that postoperative hyperbilirubinemia is a multifactorial process, which is caused by both the impaired liver function of bilirubin transport and the increased production of bilirubin from haemolysis.
明确现代体外循环术后患者高胆红素血症的发生率及性质，分析可能的围手术期危险因素，并阐明术后高胆红素血症与死亡率和发病率相关的临床意义。
2005年3月至2006年5月，对386例因各种心脏病变接受体外循环手术的连续患者进行前瞻性研究。术后高胆红素血症的发生率定义为血清总胆红素浓度超过51微摩尔/升。通过逻辑回归比较高胆红素血症患者和非高胆红素血症患者的几个围手术期参数，以确定导致术后高胆红素血症和死亡率的可能危险因素。
术后高胆红素血症的总体发生率为25.3%（98/386）。术后高胆红素血症患者中，56.2%在术后第1天达到总胆红素浓度峰值，33.5%在第2天，10.3%在第7天。总胆红素升高的80%是由结合胆红素和非结合胆红素同时升高引起的。术后高胆红素血症的发生与较高的死亡率（P<0.01）、较长的机械通气时间（P<0.05）和较长的重症监护病房停留时间（P<0.05）相关。术前总胆红素浓度、术前右心房压力、置换瓣膜数量和输血需求被确定为术后高胆红素血症的重要预测因素。
现代体外循环术后早期高胆红素血症主要由结合胆红素和非结合胆红素同时升高引起，且与高死亡率相关。重要的促成因素包括术前总胆红素浓度、术前右心房压力严重程度、瓣膜置换手术数量以及手术期间和术后不久的输血量需求。我们认为术后高胆红素血症是一个多因素过程，由胆红素转运肝功能受损和溶血导致胆红素生成增加共同引起。
