体外循环心脏术后急性肝功能损害的危险因素分析

Analysis on the risk factors of acute liver damage after cardiac operation

目的:通过分析体外循环心脏手术后肝功能损害的危险因素,认识心脏手术后肝功能损害的发生规律及特点。方法:对397例体外循环心脏手术后发生肝功能损害的相关因素进行单因素和多因素分析。结果:单因素分析显示:高龄、风湿性心脏病、慢性病毒性肝炎、术前右心衰、肝淤血、黄疸、腹水、术后严重感染、乳酸酸中毒、低心排血量及低氧血症等因素可能会导致术后急性肝功能损害的发生;多因素分析显示:术前就有肝功能损害、手术中体外循环时间长(超过2h)、手术出血多导致血制品输入量超过1000ml、术后低心排血量以及低氧血症是术后急性肝功能损害发生的独立危险因素。结论:体外循环心脏手术后肝功能损害是多种因素共同作用的结果,应提高对围术期肝功能损害危险因素的认识,正确指导临床治疗,从而避免术后急性肝功能衰竭的发生。

Objective：To analysis the risk factors,which lead to liver damage after cardiopulmonary bypass surgery. Methods： Multivariate Logistic regression analysis was performed in 397 patients with liver damage after cardiopulmonary bypass surgery. Results： One-way analysis indicated ： which lead to liver damage after cardiopulmonary bypass surgery were senility, rheumatic heart disease, chronic viral hepatitis, right heart failure before operation, hepatic congestion, jaundice,ascites,severe infection after operation,lactic acidosis,low cardiac output and hypoxemia; multivariate analysis indicated： the independent risk factors lead to liver damage after cardiopulmonary bypass surgery was liver damage before operation,longer cardiopulmonary bypass time（over 2 h）, blood transfusion over 1000ml,low cardiac output or hypoxemia. Conclusion：Multiple risk factors lead to liver damage after cardiopulmonary bypass surgery; recognize these risk factors and instruct clinic treatment can avoid the liver damage after cardiac bypass operation.