325例患者心脏瓣膜替换术围手术期肝功能的变化

Liver Function Analysis of 325 Patients After Valve Replacement Operation

目的:分析心脏瓣膜替换术患者围手术期肝功能各项指标的变化。方法:回顾性分析2004-07至2005-03于体外循环下行心脏瓣膜替换术患者共325例,其中男性129例,女性196例,年龄12～75(46.3±12.8)岁,共分为3组:A 组,乙肝标志物检测阴性且肝功能正常组(n=265);B 组,乙肝标志物检测阴性且肝功能受损组(n=32);C 组,乙肝标志物检测阳性组(n=28)。比较3组各自术前和术后第1、5、10天肝功能各项指标变化情况。结果:A 组天门冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、血清总胆红素(TBIL)、直接胆红素(DBIL)术后第1、5、10天均较术前显著增高,差异有统计学意义(P<0.05);血清白蛋白(ALB)术后第1、5天均较术前显著下降,差异有统计学意义(P<0.05)。B 组 AST、LDH、DBIL 术后第1、5天均较术前显著增高,差异有统计学意义(P<0.05);TBIL 术后第10天较术前显著增高,差异有统计学意义(P<0.05);ALB 术后第1,5天较术前下降,差异有统计学意义(P<0.05)。C 组AST、TBIL 术后第1、5、10天均较术前显著增高,差异有统计学意义(P<0.05);DBIL 术后第1、5天较术前显著增高,差异有统计学意义(P<0.05)。结论:心脏瓣膜替换术在术后早期对多项肝功能指标有一定影响,但对反映肝细胞损害的丙氨酸转氨酶(ALT)无影响。

Objective：To analyze the liver function in patients in peri-operation of valve replacement. Methods ： A total of 325 patients who received valve replacement operations with cardiopulmonary bypass from June 2004 to March 2005 were analysed retrospectively. 129 male and 196 female were involved in this study at the age of 12-75 （46.3 ± 12. 8 ） years. The patients were divided into three groups. Group A ： 265 cases were hepatitis B virus （HBV） negative with normal liver function ; Group B ： 32 cases HBV negative with abnormal liver function ; and Group C ： 28 HBV positive cases. The changes of liver function in each group were compared before and after the operation.. Results ： In group A ,aspartateaminotransferase （ AST）, lactic dehydrogenase （ LDH）, serum total bilirubin（TBIL） and direct bilirubin（DBIL） increased distinctly on the first, fifth and tenth day of post operation （ P 〈 0. 05 ） ; serum albumin （ALB） decreased significantly on the first and fifth day of post operation （ P 〈 0.05 ）. In group B, AST, LDH, DBIL increased distinctly on the first and fifth day of post operation （ P 〈 0. 05 ） ; TBIL increased distinctly on the tenth day of post operation （ P 〈 0. 05 ） ; ALB decreased on the first and fifth day of post operation. In group C, AST, TBIL increased significantly on the first, fifth and tenth day of post operation （P 〈0. 05） ; DBIL increased obviously on the first,fifth day of post operation （P 〈0. 05）. Conclusion ： The patient＇ s liver function could be injured at the early stage after valve replacement operation while no obvious changes found in alanine aminotransferase（ALT） which indicating the damage of liver cells.