成人体外膜肺氧合支持过程中高胆红素血症的发生率、危险因素及结局  

Incidence rate,risk factors and outcome of hyperbilirubinemia in adult cardiac patients supported by extracorporeal membrane oxygenation

作　　者：吕琳[1] 姚婧鑫[1] 高国栋[1] 龙村[1] 黑飞龙[1] 吉冰洋[1] 刘晋萍[1] 于坤[1] 胡金晓[1] 胡强[1] 

机构地区：[1]国家心血管病中心北京协和医学院中国医学科学院阜外医院体外循环中心,北京100037

出　　处：《实用临床医药杂志》2017年第13期56-60,共5页Journal of Clinical Medicine in Practice

基　　金：首都临床特色应用研究基金(Z111107058811090)

摘　　要：目的探讨成人体外膜肺氧合(ECMO)患者高胆红素血症的发生率、危险因素及结局。方法回顾分析阜外医院89例接受ECMO辅助支持的成人心脏病患者。所有患者分成正常组、高胆红素组、严重高胆红素组。进行多元线性回归分析时,非正态分布变量需要进行对数转换。结果高胆红素血症的发生率为73%,其中高胆红素组30例,严重高胆红素组35例。多元线性回归模型显示,lg(最高TBIL+1)和lg(最高天冬氨酸转氨酶+1)(P=0.001)、lg(最高游离血红蛋白+1)(P=0.003)、ECMO支持前TBIL(P=0.009)有相关性。二元相关系数分析显示,最高TBIL和ECMO支持前TBIL(P=0.011)、最高天冬氨酸转氨酶(P=0.004)、最高游离血红蛋白(P<0.001)具有线性相关。严重高胆红素组在ECMO辅助期间血小板数量低,且院内存活率低于其他2组。结论高胆红素血症在ECMO辅助期间比较常见。严重高胆红素血症与血小板数量下降和高院内死亡率有关。溶血、肝功能障碍、ECMO前高TBIL是ECMO辅助期间高胆红素血症的危险因素。Objective To explore the incidence rate,risk factors and outcome of hyperbilirubinemia in adult cardiac patients supported by extracorporeal membrane oxygenation（ ECMO）.Methods Clinical data of 89 adult cardiac patients with ECMO in Fuwai Hospital were retrospectively analyzed. All patients were divided into normal group,high bilirubin group and severe high bilirubin group. In a multiple linear regression analysis,logarithmic transformation was performed for nonnormally distributed variables. Results The incidence rate of hyperbilirubinemia was 73%,including 30 cases in high bilirubin group and 35 cases in severe high bilirubin group. A multiple linear regression analysis showed that lg（ peak TBIL ＋ 1） was significantly associated with lg（ peak AST ＋1）（ P = 0. 001）,lg（ peak free hemoglobin ＋ 1）（ P = 0. 003） and TBIL before ECMO（ P =0. 009）. There was also a linear correlation between peak TBIL and TBIL before ECMO support（ P =0. 011）,peak AST（ P = 0. 004） and peak free hemoglobin during ECMO（ P〈0. 001）. The patients in severe high bilirubin group had lower platelets during ECMO,and the survival rate was the lowest.Conclusion Hyperbilirubinemia remains common in patients with ECMO,and is associated with low platelet and a high rate of in-hospital mortality. Hemolysis and liver dysfunction during ECMO support and high bilirubin level before ECMO are risk factors of hyperbilirubinemia.

关 键 词：体外膜肺氧合 高胆红素血症 危险因素 

分 类 号：R563.8[医药卫生—呼吸系统]