Lyu Lin, Yao Jingxin, Gao Guodong, Long Cun, Hei Feilong, Ji Bingyang, Liu Jinping, Yu Kun, Hu Qiang, Hu Jinxiao
Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Artif Organs. 2018 Feb;42(2):148-154. doi: 10.1111/aor.12979. Epub 2017 Sep 6.
The aims of this study were to evaluate the incidence, risk factors, and outcomes of hyperbilirubinemia in cardiac patients with veno-arterial (VA) ECMO. Data on 89 adult patients with cardiac diseases who received VA ECMO implantation in our hospital were retrospectively reviewed. All patients were divided into the following three groups: 24 in normal group (N, total bilirubin [TBIL] ≤3 mg/dL), 30 in high bilirubin group (HB, 6 mg/dL ≥ TBIL > 3 mg/dL), and 35 in severe high bilirubin group (SHB, TBIL > 6 mg/dL). lg(variables + 1) was performed for nonnormally distributed variables. The incidence of hyperbilirubinemia (>3 mg/dL) was 73%. In a multiple linear regression analysis, lg(peak TBIL + 1) was significantly associated with lg(peak AST + 1) (b-coefficient 0.188, P = 0.001), lg(peak pFHb + 1) (b-coefficient 0.201, P = 0.003), and basic TBIL (b-coefficient 0.006, P = 0.009). Repeated measurement analysis of variance revealed that the main effect for three groups in pFHb and lg(AST + 1) was significant at first 3 days during ECMO. The patients in SHB had low platelets during ECMO and low in-hospital survival rate. Hyperbilirubinemia remains common in patients with VA ECMO and is associated with low platelets and high in-hospital mortality. Hemolysis and liver dysfunction during ECMO and basic high bilirubin levels are risk factors of hyperbilirubinemia.
本研究旨在评估接受静脉-动脉（VA）体外膜肺氧合（ECMO）的心脏患者高胆红素血症的发生率、危险因素及预后。回顾性分析了我院89例接受VA-ECMO植入的成年心脏病患者的数据。所有患者分为以下三组：正常组（N组，总胆红素[TBIL]≤3mg/dL）24例，高胆红素组（HB组，6mg/dL≥TBIL>3mg/dL）30例，重度高胆红素组（SHB组，TBIL>6mg/dL）35例。对非正态分布变量进行lg（变量+1）转换。高胆红素血症（>3mg/dL）的发生率为73%。多线性回归分析显示，lg（最高TBIL+1）与lg（最高AST+1）（b系数0.188，P=0.001）、lg（最高pFHb+1）（b系数0.201，P=0.003）和基础TBIL（b系数0.006，P=0.009）显著相关。重复测量方差分析显示，ECMO开始后3天内，三组在pFHb和lg（AST+1）方面的主效应显著。SHB组患者在ECMO期间血小板计数低，住院生存率低。高胆红素血症在VA-ECMO患者中仍然常见，并且与血小板计数低和住院死亡率高相关。ECMO期间的溶血和肝功能障碍以及基础高胆红素水平是高胆红素血症的危险因素。
