Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Ann Thorac Surg. 2010 Mar;89(3):811-7. doi: 10.1016/j.athoracsur.2009.12.021.
Variable outcomes of cardiac operations have been reported in cirrhotic patients, but no definitive predictive prognostic factors have been established. This retrospective study assessed operative results to identify risk factors associated with morbidity after cardiovascular operations in cirrhotic patients.
The study comprised 42 cirrhotic patients who underwent cardiovascular operations from January 1991 to January 2009. Thirty patients were Child-Turcotte-Pugh class A, and 12 were class B. Hospital morbidity occurred in 13 patients (31.0%; M group), including 4 who died in-hospital. Patients without severe complications (N group) were compared with the M group patients. The Model for End-Stage Liver Disease (MELD) score was evaluated in 25 patients.
Significant differences in hospital morbidity between the M vs N groups were identified for platelet count (8.7 +/- 3.8 vs 12.1 +/- 4.2 x 10(4)/microL), MELD score (17.8 +/- 5.3 vs 9.8 +/- 4.9), operation time (370 +/- 88 vs 313 +/- 94 minutes), and cardiopulmonary bypass time (174 +/- 46 vs 149 +/- 53 minutes) in univariate analyses (p < 0.005). Platelet count, operation time, and age were significantly associated with hospital morbidity in multivariate analyses (p < 0.005). Platelet count of 9.6 x 10(4)/microL and MELD score of 13 were cutoff values for hospital morbidity.
Careful consideration of operative indications and methods are necessary in cirrhotic patients with low platelet counts or high MELD scores. A high incidence of hospital morbidity is predicted in patients with platelet counts of less than 9.6 x 10(4)/microL or MELD scores exceeding 13.
在肝硬化患者中，心脏手术的结果存在差异，但尚未确定明确的预测预后因素。本回顾性研究评估了手术结果，以确定与肝硬化患者心血管手术后发病率相关的危险因素。
本研究纳入了 1991 年 1 月至 2009 年 1 月期间接受心血管手术的 42 例肝硬化患者。30 例患者为 Child-Turcotte-Pugh 分级 A，12 例为分级 B。13 例患者（31.0%；M 组）发生院内并发症，包括 4 例院内死亡。将无严重并发症的患者（N 组）与 M 组患者进行比较。在 25 例患者中评估了终末期肝病模型（MELD）评分。
M 组与 N 组患者在血小板计数（8.7 ± 3.8 与 12.1 ± 4.2×10^4/μL）、MELD 评分（17.8 ± 5.3 与 9.8 ± 4.9）、手术时间（370 ± 88 与 313 ± 94 分钟）和体外循环时间（174 ± 46 与 149 ± 53 分钟）方面存在显著差异（p<0.005）。多变量分析显示，血小板计数、手术时间和年龄与院内发病率显著相关（p<0.005）。血小板计数 9.6×10^4/μL 和 MELD 评分 13 是预测院内发病率的截断值。
对于血小板计数低或 MELD 评分高的肝硬化患者，需要仔细考虑手术适应证和方法。血小板计数<9.6×10^4/μL 或 MELD 评分>13 的患者发生院内高发病率的风险较高。
