急性A型主动脉夹层术后肝功能不全危险因素研究  

Analysis of risk factors of hepatic insufficiency after surgery for acute type A aortic dissection

作　　者：王国权[1] 翟水亭[1] 史帅涛[1] 张志东[1] 李坤[1] WANG Guoquan;ZHAI Shuiting;SHI Shuaitao;ZHANG Zhidong;LI Kun(Dept. of Vascular Surgery,Henan Provincial People's Hospital & Fuwai Central China Cardiovascular Hospital,Zhengzhou 450003,Henan,China)

机构地区：[1]河南省人民医院/阜外华中心血管病医院血管外科

出　　处：《武汉大学学报（医学版）》2019年第1期130-132,共3页Medical Journal of Wuhan University

基　　金：国家自然科学基金资助项目(编号:81301328);河南省医学科技攻关项目(编号:201403150)

摘　　要：目的:回顾研究急性A型主动脉夹层弓部置换术后肝功能不全的相关危险因素。方法:汇集2014年2月-2017年8月我院成功实施弓部置换的A型主动脉夹层患者122例,监测术后1周内血液中谷氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBil)和乳酸脱氢酶(LDH)水平,根据是否出现术后肝功能不全分为两组,结合临床资料分析术后肝功能不全的危险因素。结果:主动脉夹层弓部置换术后肝功能不全的发生率为14.8%。单因素方差分析结果提示与术后肝功能不全发生有关的危险因素包括术前ALT>40U/L,腹腔干动脉夹层,主动脉阻断时间,术中及术后24h内输入红细胞超过10U,术后低氧血症。多因素Logsistic回归分析结果表明术前ALT>40U/L,术中及术后24h输入红细胞超过10U是术后肝功能不全的危险因素。结论:急性主动脉夹层全弓置换术后肝功能不全跟多种相关因素有关,而术前ALT>40U/L,术中及术后24h输入红细胞超过10U是夹层围手术期肝功能不全的主要危险因素。Objective: To research incidence and influencing factors of postoperative hepatic insufficiency after acute type A aortic dissection with aortic arch replacement. Methods: We analyzed 122 patients with type A aortic dissection undergoing aortic arch replacement surgery from February 2014 to August2017 in our hospital, monitoring the blood alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBil) and lactate dehydrogenase(LDH) assay one week after surgery. Patients were divided into two groups based on whether or not postoperative liver dysfunction occurred,and risk factors for postoperative liver dysfunction were analyzed according to clinical data. Results:The incidence of hepatic insufficiency after aortic dissection surgery was 14.8%. Univariate analysis of variance showed that the risk factors related to the occurrence of postoperative hepatic dysfunction included preoperative ALT>40 U/L, intracavitary artery dissection, aortic occlusion time, intraoperative and postoperative 24 h input of red blood cells more than 10 U, postoperative hypoxemia. Multi-variate logistic regression analysis showed that preoperative ALT>40 U/L, intraoperative and postoperative24 h input of red blood cells more than 10 U were risk factors for postoperative liver dysfunction.Conclusion: Postoperative liver dysfunction after aortic arch replacement surgery is associated with a variety of related factors, and preoperative ALT>40 U/L, intraoperative and postoperative 24 h input of red blood cells more than 10 U are the most important risk factors for postoperative liver dysfunction.

关 键 词：主动脉弓部置换 术后肝功能不全 危险因素 

分 类 号：R654.3[医药卫生—外科学]