Liu Nan, Sun Li-Zhong, Chang Qian
Department of Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Wai Ke Za Zhi. 2010 Aug 1;48(15):1154-7.
To analyze the risk factors of hepatic dysfunction following Stanford A and stanford B aortic dissection repair with deep hypothermic circulatory arrest (DHCA).
Between January 2006 and June 2008, 208 patients [156 male and 52 female, mean aged (45 ± 11) years] underwent open repairs of aortic dissection with DHCA. Indications for surgical intervention were type A aortic dissection in 181 patients and type B in 27 patients. Acute aortic dissection occurred on 121 patients, chronic aortic dissection occurred on 87 patients. Complications included hypertension, diabetes, cardiac dysfunction, renal dysfunction, and hepatic dysfunction. Twenty-one patients had previous aortic surgery. Data were gathered for multiple preoperative and intraoperative factors including age, gender, diagnosis, aortic dissection type, preoperative ejection fraction, aortic surgery history, surgical intervention type, cardiopulmonary bypass (CPB) time, aortic cross-clamp time, blood transfusion volume (PRBC). Serum glutamic-pyruvic transaminase (GPT), 1-lactate dehydrogenase (LDH) and total bilirubin (TBIL) were assayed before and after operation, as well as 12 h, 1 d, 3 d, 5 d, 7 d. These valuables were recorded and described statistically. All the factors were evaluated by means of univariate and multivariate Logistic analysis to identify relative risk factors of hepatic dysfunction.
The CPB time and aortic cross-clamp time were (189 ± 48) min and (93 ± 41) min, respectively. Hepatic dysfunction occurred in 18 (8.7%) patients. Serum GPT and serum LDH elevated significantly within 24 h after aortic surgery, and then went down gradually. Postoperative serum TBIL were much higher than preoperative level on the first day and there was no significant reduction during the following seven days. Preoperative serum creatinine > 133 µmol/L (P < 0.01), preoperative GPT > 40 U/L (P < 0.01), acute aortic dissection (P < 0.05), CPB time > 180 min (P < 0.05), aortic cross-clamp time > 100 min (P = 0.035), PRBC > 10 unit (P < 0.01) were the risk factors for hepatic dysfunction. Furthermore preoperative GPT > 40 U/L (P < 0.01) and PRBC > 10 unit (P < 0.01) were independent determinants for hepatic dysfunction.
Multiple risk factors impact the onset of postoperative hepatic dysfunction. Rather, a combination of factors, especially preoperative hepatic injury, massive blood transfusion produced the highest odds of deficit.
分析在采用深低温停循环（DHCA）进行斯坦福A型和B型主动脉夹层修复术后肝功能障碍的危险因素。
2006年1月至2008年6月期间，208例患者[男性156例，女性52例，平均年龄（45±11）岁]接受了采用DHCA的主动脉夹层开放修复术。手术干预的指征为181例A型主动脉夹层和27例B型主动脉夹层。121例患者发生急性主动脉夹层，87例患者发生慢性主动脉夹层。并发症包括高血压、糖尿病、心功能不全、肾功能不全和肝功能不全。21例患者既往有主动脉手术史。收集了多个术前和术中因素的数据，包括年龄、性别、诊断、主动脉夹层类型、术前射血分数、主动脉手术史、手术干预类型、体外循环（CPB）时间、主动脉阻断时间、输血量（红细胞悬液）。分别在手术前后以及术后12小时、1天、3天、5天、7天测定血清谷丙转氨酶（GPT）、乳酸脱氢酶（LDH）和总胆红素（TBIL）。记录这些数值并进行统计学描述。通过单因素和多因素Logistic分析评估所有因素，以确定肝功能障碍的相关危险因素。
CPB时间和主动脉阻断时间分别为（189±48）分钟和（93±41）分钟。18例（8.7%）患者发生肝功能障碍。主动脉手术后24小时内血清GPT和血清LDH显著升高，然后逐渐下降。术后第1天血清TBIL远高于术前水平，且在随后7天内无明显下降。术前血清肌酐>133μmol/L（P<0.01）、术前GPT>40 U/L（P<0.01）、急性主动脉夹层（P<0.05）、CPB时间>180分钟（P<0.05）、主动脉阻断时间>100分钟（P=0.035）、红细胞悬液>10单位（P<0.01）是肝功能障碍的危险因素。此外，术前GPT>40 U/L（P<0.01）和红细胞悬液>10单位（P<0.01）是肝功能障碍的独立决定因素。
多种危险因素影响术后肝功能障碍的发生。确切地说，多种因素的组合，尤其是术前肝损伤、大量输血导致肝功能障碍的几率最高。
