单纯瓣膜置换术后高胆红素血症的危险因素分析及其临床预后  

Risk factors and clinical prognosis of hyperbilirubinemia after isolated heart valve replacement

作　　者：徐先增[1] 周婷[1] 谢晓勇[2] 雷宾峰[2] 冯旭[2] 郑宝石[2] 

机构地区：[1]广西医科大学第一附属医院心胸外科重症监护室,广西壮族自治区南宁5300211 [2]广西医科大学第一附属医院心外科,广西壮族自治区南宁5300211

出　　处：《中华危重症医学杂志（电子版）》2015年第6期356-360,共5页Chinese Journal of Critical Care Medicine:Electronic Edition

摘　　要：目的探究单纯瓣膜置换术（heart valve prosthesis implantation,HVPI）术后高胆红素血症的发生率、危险因素及对患者临床预后的影响。方法回顾性分析广西医科大学第一附属医院心外科2013年收治的400例HVPI患者。根据患者术后一周内血清总胆红素峰值是否≥34.2μmol/L分成A组（高胆红素血症,124例）、B组（非高胆红素血症,276例）。记录并比较两组患者人口学特征、术前及术后等相关变量,并采用Logistic回归模型分析HVPI术后单纯高胆红素血症的独立危险因素。同时,对两组患者的ICU滞留天数、呼吸机应用时间及病死率进行预后分析。结果 A、B两组在术前因素包括总胆红素水平（t=8.433,P〈0.001）、丙氨酸转氨酶水平（t=2.871,P=0.004）、左室射血分数（t=2.413,P=0.016）、肺动脉收缩压（t=2.686,P=0.008）、中度以上三尖瓣关闭不全（χ~2=15.825,P〈0.001）,术后因素包括WBC（t=2.577,P=0.010）、血小板计数（t=2.000,P=0.046）的比较,差异均有统计学意义。Logistic多因素回归分析发现术前总胆红素水平（OR：4.212;95%CI：2.538~6.988;χ~2=31.730;P〈0.001）、是否有中度以上三尖瓣关闭不全（OR：1.945;95%CI：1.015~3.727;χ~2=6.311;P=0.010）及丙氨酸转氨酶（OR：3.810;95%CI：1.705~8.511;χ~2=11.593;P〈0.001）是术后高胆红素血症的独立危险因素。A组患者ICU滞留天数〉2 d及病死率均显著高于B组患者（χ~2=4.861、5.513,P=0.027、0.019）,而两组患者呼吸机应用时间〉24 h的比较,差异无统计学意义（χ~2=0.930,P=0.335）。结论 HVPI术后患者总胆红素水平明显增加,患者术前总胆红素水平、是否存在中度以上三尖瓣关闭不全和丙氨酸转氨酶水平等是高胆红素血症与的独立相关因素。且术后高胆红素血症可导致患者病死率增加和ICU滞留时间延长。Objective To analyze the incidence, risk factors and impact on clinical outcomes of hyperbilirubinemia after isolated heart valve prosthesis implantation（HVPI）.Methods Totally of 400 patients undergone HVPI surgery from the First Affiliated Hospital of Guangxi Medical University in 2013 were enrolled and divided into group A（hyperbilirubinemia, 124 cases） and group B（non-hyperbilirubinemia, 276 cases）. Hyperbilirubinemia was defined as peak serum bilirubin level ≥ 34.2 μmol / L on postoperative day 7 after HVPI.The preoperative and postoperative total bilirubin concentration were recorded as well as associated demographics, preoperative, intraoperative and postoperative correlated variables,and all the data were compared between the two groups. The Logistic regression was used to analyze HVPI independent risk factors for postoperative hyperbilirubinemia. Meanwhile, the ICU stay time, breathing machine application time and fatality rate were compared between the two groups using univariate and multivariate statistical methods. Hyperbilirubinemia was defined as peak serum bilirubin level ≥ 34.2 μmol / L within a week after HVPI. Results The levels of total bilirubin level（t = 8.433,P〈0.001）, alanine aminotransferase level（t = 2.871, P = 0.004）,left ventricular ejection fraction（t = 2.413, P = 0.016）, pulmonary arterial systolic pressure（t =2.686, P = 0.008）, moderate or severe tricuspid regurgitation（ χ~2= 15.825,P〈0.001） before operation,and white blood cell count（t = 2.577, P = 0.010）, blood platelet count（t = 2.000, P = 0.046）after operation all showed significant differences between the two groups. The Logistic regression found that preoperative total bilirubin（OR： 4.212; 95%CI： 2.538 ~ 6.988; χ~2= 31.730;P〈0.001）,moderate or severe tricuspid regurgitation（ OR： 1.945; 95%CI： 1.015 ~ 3.727; χ~2= 6.311; P =0.010） and alanine aminotransferase（OR： 3.810; 95% CI： 1.705 ~ 8.511; χ~2= 11.593;P〈0.001）were the independent risk factors of h

关 键 词：心脏瓣膜假体植入 高胆红素血症 危险因素 预后 

分 类 号：R654.2[医药卫生—外科学]