Klemperer J D, Ko W, Krieger K H, Connolly M, Rosengart T K, Altorki N K, Lang S, Isom O W
Department of Cardiothoracic Surgery, New York Hospital-Cornell University Medical Center, New York 10021, USA.
Ann Thorac Surg. 1998 Jan;65(1):85-7. doi: 10.1016/s0003-4975(97)00931-4.
A retrospective review was performed to determine the outcome after cardiac operations in patients with a documented history of noncardiac cirrhosis.
The charts of patients admitted to the cardiothoracic surgical service between 1990 and 1996 were reviewed, and 13 patients with a preoperative history of cirrhosis were identified. The severity of preoperative liver disease was graded according to the criteria of Child.
Most of the cases of cirrhosis were alcohol-related. Eight patients were classified as having Child class A and 5 as having Child class B cirrhosis. One hundred percent of patients with Child class B and 25% of those with Child class A cirrhosis had major complications. The postoperative chest tube output and transfusion requirements of these patients were approximately three times higher than average. The overall perioperative mortality rate was 31%. In patients with Child class B cirrhosis, the mortality rate was 80%. No patient with Child class A cirrhosis died. Deaths were related to gastrointestinal and septic complications, and not to cardiovascular failure.
These findings suggest that patients with minimal clinical evidence of cirrhosis can tolerate cardiopulmonary bypass and cardiac surgical procedures, whereas those with more advanced liver disease should not be offered operation.
进行一项回顾性研究以确定有非心脏性肝硬化病史的患者心脏手术后的结局。
回顾1990年至1996年间心胸外科收治患者的病历，确定13例术前有肝硬化病史的患者。根据Child标准对术前肝病的严重程度进行分级。
大多数肝硬化病例与酒精有关。8例患者被归类为Child A级，5例为Child B级肝硬化。Child B级患者中有100%以及Child A级肝硬化患者中有25%发生了严重并发症。这些患者术后胸管引流量和输血量约为平均水平的三倍。围手术期总死亡率为31%。Child B级肝硬化患者的死亡率为80%。Child A级肝硬化患者无死亡病例。死亡与胃肠道和感染性并发症有关，而非心血管衰竭。
这些发现表明，临床肝硬化证据轻微的患者能够耐受体外循环和心脏手术，而肝病较严重的患者不应接受手术治疗。
