体外膜肺氧合辅助后高胆红素血症的临床意义

Hyperbilirubinemia in adult patients who undergo cardiotomy with extracorporeal membrane oxygenation support

目的 探讨体外膜肺氧合（ECMO）辅助病人高胆红素血症的发病率及其对住院死亡的影响.方法 收集2005年至2008年65例应用ECMO辅助的成年病人资料,记录血流动力学、血牛化指标等以及临床转归.结果 51例成功脱离ECMO,脱机率为78.5%,33例生存出院,总病死率49.2%.55.4%的ECMO辅助病人发生高胆红素血症,其病死率明显高于非高胆红素血症组（P〈0.01）.Logis-tic回归分析显示,高胆红素血症明显增加病人住院死亡风险（OR=3.895,P〈0.01）.结论 高胆红素血症在ECMO辅助病人中的发病率较高,是增加术后病死率的影响因素之一,应及时处理,以改善病人的临床转归.

Objective The incidence of post-operative hyperbilirubinemia, which is associated with poor outcomes in patients, was reported to be increased in recent years though it has been a rare complication for cardiac operations. Post-operative impairment of liver function is highlighted. We evaluated the incidence and prognosis of post-operative hyperbilirubinemia in adult patients who underwent cardiotomy with extracorporeal membrane oxygenation （ECMO） support. Methods Sixty-five adult patients who had received ECMO support after cardiac surgery from 2004 to 2008 were enrolled and evaluated retrospectively. Post-operafive hyperbilirubinemia was defined as the serum level of the total bilirubin more than 51.3 p.mol/L during postoperative period. Demographic and clinical data included gender, age, types of surgery, perioperative hemodynamic param- eters, biochemical variables, duration of the ventilation support, ICU stay and outconms. Results The mean age of the pa- tients was （50.1 ± 13.9） years, forty-six patients（70.8% ） were male. The main cardiac procedures were heart transplantation for 9 patients, coronary artery bypass grafting and/or valve operations for 47 patients, congenital heart disease correction for 4 patients and other operations for 5 patients. Among all patients, fifty-one patients（78.5% ） were weaned from ECMO successfully and thirty-three patients were discharged from hospital. The overall mortality rate was 49.2%. Overall incidence of post-operative hyperbilirubinemia was 55.4%. In patients with postoperative hyperbilirubinemia, the mean peak value for serum total bilirubin was 104.8 （68.5-156.7） μmoL/1. The hospital mortality in the hyperbilirubinemia group was significantly higher than that in the non-hyperbilirubinemia group（66.7% vs. 27.6%, P 〈 0.01 ）. Moreover, postoperative hyperbilirubinemia （ odds ratio = 3. 895, 95 % confidence interval, 1. 088 - 13. 947 ; P = 0. 037 ） and SOFA score （ odds ratio = 1. 214, 95 % confidence interval, 0. 987 -1. 494, P = 0. 047） and APACHE III score （odds ratio = 1. 096, 95% confidence interval, 1. 028 - 1. 169 ; P = 0. 004 ） were associated with hospital mortality after adjusting for preoperative levels of the total bilirubin, direct bilirubin, gender and age. Conclusion Postoperative hyperbilirubinemia is one of the complications in adult patients who undergo eardiotomy with ECMO support, and is associated with increased hospital mortality.