心脏外科术后高胆红素血症及危险因素分析

Frequency, risk factors, and prognosis of hyperbilirubinemia after cardiac surgery

目的探讨影响心脏外科术后高胆红素血症发生及其术前与术中危险因素。方法选择2012年1月至2012年5月期间在我科行择期心脏手术的成人患者168例,总结其人口学资料及相关的临床资料。以高胆红素血症组为研究组,非高胆红素血症组为对照组进行比较研究。结果本组168例中,术后发生高胆红素血症73例,发生率为43.4%。单因素分析提示,术前谷丙转氨酶水平、转肽酶、血清总胆红素、直接胆红素、间接胆红素,术前左房前后径、左室射血分数、二尖瓣与主动脉瓣狭窄的发生率、合并同期瓣膜手术、术中失血、术中输血输浆、手术及总麻醉时间是术后高胆红素血症的危险因素（P〈0.05）。多因素分析提示,术前血清总胆红素水平（OR 1.440,95%CI 1.216-1.706,P=0.000）与手术时间（OR 5.745,95%CI 1.143-28.877,P=0.034）是术后高胆红素血症的独立危险因素。高胆红素血症组患者术后24 h引流量显著高于对照组,总呼吸机辅助时间、ICU时间以及术后总住院时间亦显著增加（P〈0.05）,但围手术期死亡率并未显著增加（P=0.974）。结论高胆红素血症在心脏外科术后发生率较高,术前血清总胆红素升高和手术时间的延长是术后高胆红素血症发生的独立危险因素,高胆红素血症的发生与术后机械通气时间、ICU时间以及术后总住院时间的延长显著相关。

Objective To investigate the frequency, risk Factors, and prognosis of hyperbilirubinemia after cardiac surgery. Methods 168 patients who underwent elective cardiac surgery during 2012.1.1- 2012.5.31 were included retrospectively. Patients were divided into the experimental group with post-operative hyperbilirubinemia while others served as controls. Differences of the clinical data were compared between the two groups.And multivariable logistic regression modeling was used to identify the risk factors. Results Hyperbilirubinemia occurred in 43.4%（73/168） patients. The experimental group had prolonged mechanical ventilation, ICU stay and post-operative hospital stays（P〈 0.05）, but not significantly higher mortality（P = 0.974）. There was significant difference between the two groups in preoperative ALT,GGT, serum total bilirubin, direct bilirubin, indirect bilirubin, left atrial diameter, left ventricular ejection fraction, mitral stenosis,arotic stenosis, combined valve surgery, intraoperatie blood loss, intraoperative transfusion of blood and plasma,operation duration and anesthesia duration（P〈 0.05）. Preoperative serum total bilirubin（OR 1.440,95%CI 1.216-1.706,P = 0.000）,and operation duration（OR 5.745, 95%CI 1.143-28.877,P = 0.034）were independent risk factors for post-operative hyperbilirubinemia in multivariable logistic regession analysis. Conclusion The frequency of post-operative hyperbilirubinemia after cardiac surgrey is moderately high. Preoperative serum total bilirubin and operation duration are independent risk factorsfor post-operative hyperbilirubinemia. Patients with hyperbilirubinemia have prolonged mechanical ventilation time, ICU stay and post-operative hospital stays.