心脏手术后的术后黄疸

Postoperative jaundice after cardiac surgery.

作者信息

Mastoraki Aikaterini, Karatzis Emmanouil, Mastoraki Sotiria, Kriaras Ioannis, Sfirakis Petros, Geroulanos Stefanos

机构信息

Department of Surgical Intensive Care Unit, Onassis Cardiac Surgery Center, 356 Sygrou Ave, 17674 Athens, Greece.

出版信息

Hepatobiliary Pancreat Dis Int. 2007 Aug;6(4):383-7.

PMID:17690034

Abstract

BACKGROUND

The frequency and pattern of hyperbilirubinemia after open-heart surgery and its severe perioperative complications are not well clarified. The purpose of this study was to investigate the incidence and nature of postoperative jaundice in patients undergoing cardiac operation, to analyze the determinants, and to identify the clinical significance of this complication with regard to the associated morbidity and mortality.

METHODS

A prospective observational study was made during the period of 2003-2004 in a Surgical Intensive Care Unit of a Cardiac Surgery Center, Athens. One hundred twenty-eight adult patients for open heart surgery were divided into three groups. Group A included 50 patients who underwent coronary artery bypass crafting (CABG), group B 31 patients who were subjected to aortic valve replacement (AVR)+CABG and group C 47 patients who underwent mitral valve replacement (MVR)+CABG. Aminotransferases, alkaline phosphatase, gamma-glutamyl-transpeptidase and both types of bilirubin were determined at admission, 24 hours after the operation and thereafter according to clinical evolution. The presence of jaundice was associated with elevated serum bilirubin above 3 mg/dl.

RESULTS

Hyperbilirubinemia developed in 34 patients (26.5%). The incidence of postoperative jaundice was higher in patients who were subjected to MVR+CABG than to CABG and AVR+CABG. Hyperbilirubinemia was correlated with prolonged cardiopulmonary by-pass time (P<0.001), aortic cross-clamping time (P<0.001), the use of intra aortic balloon pumping (P<0.001), the administration of inotrops and the number of blood and plasma transfusions. Postoperative jaundice resulted mainly from an increase in conjugated bilirubin.

CONCLUSIONS

Although hyperbilirubinemia seems to be multifactorial, the type of operation, the preoperative hepatic dysfunction due to advanced heart failure (NYHA II-III) and the decreased hepatic flow during the operation seem to determine the incidence of jaundice.

摘要

背景

心脏直视手术后高胆红素血症的发生率和模式及其严重的围手术期并发症尚未完全阐明。本研究的目的是调查心脏手术患者术后黄疸的发生率和性质，分析其决定因素，并确定该并发症在相关发病率和死亡率方面的临床意义。

方法

2003年至2004年期间，在雅典一家心脏外科中心的外科重症监护病房进行了一项前瞻性观察研究。128例接受心脏直视手术的成年患者被分为三组。A组包括50例行冠状动脉旁路移植术（CABG）的患者，B组包括31例行主动脉瓣置换术（AVR）+CABG的患者，C组包括47例行二尖瓣置换术（MVR）+CABG的患者。在入院时、手术后24小时以及此后根据临床进展情况测定转氨酶、碱性磷酸酶、γ-谷氨酰转肽酶和两种胆红素。黄疸的出现与血清胆红素升高超过3mg/dl相关。

结果

34例患者（26.5%）出现高胆红素血症。接受MVR+CABG的患者术后黄疸发生率高于接受CABG和AVR+CABG的患者。高胆红素血症与体外循环时间延长（P<0.001）、主动脉阻断时间（P<0.001）、主动脉内球囊反搏的使用（P<0.001）、血管活性药物的使用以及血液和血浆输注量相关。术后黄疸主要是由于结合胆红素增加所致。