Wang M J, Chao A, Huang C H, Tsai C H, Lin F Y, Wang S S, Liu C C, Chu S H
Department of Anesthesiology, National Taiwan University Hospital, Taipei.
J Thorac Cardiovasc Surg. 1994 Sep;108(3):429-36.
Three hundred and two consecutive patients who had undergone cardiac operation for various cardiac lesions were studied prospectively to evaluate the incidence, risk factors, and the associated mortality of postoperative hyperbilirubinemia after cardiopulmonary bypass. Concentrations of the serum total (conjugated and unconjugated) bilirubin, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, alkaline phosphatase, albumin, globulin, and serum haptoglobin were measured before the operation and again on the first, second, and seventh postoperative days. Postoperative hyperbilirubinemia was defined as occurrence of a serum total bilirubin concentration of more than 3 mg/dl in any measurement during the postoperative period. Logistic regression was done to identify possible risk factors for postoperative hyperbilirubinemia. Overall incidence of postoperative hyperbilirubinemia was 35.1%; the incidence of postoperative hyperbilirubinemia was higher in patients whose valves were replaced with mechanical prostheses than in those without prostheses (p < 0.00001). In patients with postoperative hyperbilirubinemia, 70% of the increase of total bilirubin on the first postoperative day came about from an increase in unconjugated bilirubin. Serum haptoglobin decreased significantly at the same time (p < 0.01). Development of the postoperative hyperbilirubinemia was associated with a higher mortality (5.6% versus 0.5%, p < 0.01) and higher frequency of use of intraaortic balloon counterpulsation, especially for patients in whom the highest postoperative total bilirubin occurred after the first 2 days. The numbers of valves replaced, preoperative right atrial pressure, and preoperative total bilirubin concentration are the significant risk factors that, in combination, correctly predict the occurrence of postoperative hyperbilirubinemia in 80% of the patients. We concluded that postoperative hyperbilirubinemia results mainly from an increase in unconjugated bilirubin and is associated with higher mortality, especially for patients in whom highest postoperative total bilirubin occurred late after operation. Patients with the higher preoperative right atrial pressure and total bilirubin level who then underwent multiple valve replacement procedures are at greater risk for development of postoperative hyperbilirubinemia.
对302例因各种心脏病变接受心脏手术的连续患者进行前瞻性研究，以评估体外循环术后高胆红素血症的发生率、危险因素及相关死亡率。在手术前以及术后第1天、第2天和第7天分别测量血清总胆红素（结合胆红素和非结合胆红素）、丙氨酸转氨酶、天冬氨酸转氨酶、乳酸脱氢酶、碱性磷酸酶、白蛋白、球蛋白和血清触珠蛋白的浓度。术后高胆红素血症定义为术后任何一次测量中血清总胆红素浓度超过3mg/dl。采用逻辑回归分析确定术后高胆红素血症的可能危险因素。术后高胆红素血症的总体发生率为35.1%；瓣膜置换为机械瓣膜的患者术后高胆红素血症的发生率高于未置换瓣膜的患者（p<0.00001）。术后发生高胆红素血症的患者中，术后第1天总胆红素升高的70%来自非结合胆红素的增加。同时血清触珠蛋白显著降低（p<0.01）。术后高胆红素血症的发生与较高的死亡率相关（5.6%对0.5%，p<0.01），且主动脉内球囊反搏的使用频率更高，尤其是术后第2天以后血清总胆红素最高的患者。置换瓣膜的数量、术前右心房压力和术前总胆红素浓度是重要的危险因素，三者结合可正确预测80%患者术后高胆红素血症的发生。我们得出结论，术后高胆红素血症主要由非结合胆红素增加引起，且与较高的死亡率相关，尤其是术后血清总胆红素最高出现在术后较晚时间的患者。术前右心房压力和总胆红素水平较高且接受多次瓣膜置换手术的患者发生术后高胆红素血症的风险更大。
