体外循环辅助下心血管手术后高胆红素血症发生的风险因素和阈值分析  

Analysis of risk factors and threshold of hyperbilirubinemia after cardiovascular surgery assisted by cardiopulmonary bypass

作　　者：王星宇[1] 王超 夏雄 魏宏逵 魏翔[1] Wang Xingyu;Wang Chao;Xia Xiong;Wei Hongkui;Wei Xiang(Division of Cardiothoracic and Vascular Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Animal Nutrition and Feed Science,College of Animal Science and Technology,Huazhong Agricultural University,Wuhan 430070,China)

机构地区：[1]华中科技大学同济医学院附属同济医院心脏大血管外科,武汉430030 [2]华中农业大学动物科技学院动物营养与饲料科学系,武汉430070

出　　处：《中华胸心血管外科杂志》2022年第5期287-291,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的回顾性分析体外循环(CPB)辅助下心血管手术后高胆红素血症发生的风险因素,预测关键因素的风险阈值。方法收集2017年1月至2019年3月期间1286例CPB辅助下各类成人心血管手术患者资料。记录围手术期临床资料和血清总胆红素峰值。采用logistic回归多因素分析法界定风险因素,采用折线分析法预测危险阈值。结果312例(24.26%)术后出现高胆红素血症,手术类型主要为瓣膜手术(142例,45.51%)、大血管开放手术(118例,37.82%)和先天性心脏病矫治术(24例,7.69%)。高胆红素血症患者住院病死率34.62%(108/312),术后ICU住院6天,术后机械通气68 h,均显著高于非高胆红素血症患者(P<0.01)。术后高胆红素血症高危风险因素包括术后机械通气时间>49 h、CPB时间>181 min、术前肝功能异常、术后主动脉内球囊反搏和体外膜肺氧合、非计划性二次开胸探查等(P<0.01)。其中,术后机械通气时间和CPB时间影响高胆红素血症发病率、ICU住院天数、住院病死率的风险阈值分别为120.21 h和143.26 min,248.20 h和239.51 min,259.50 h和190.60 min。结论术前肝功能异常、术中CPB时间、术后机械通气时间、术后使用IABP或ECMO辅助、非计划性二次开胸探查是CPB辅助下心血管手术后高胆红素血症的高危风险因素。Objective To investigate the perioperative risk factors in contribution of hyperbilirubinemia following cardiopulmonary bypass(CPB)assisted cardiovascular surgery,of which cutoff values of key factors are defined.Methods 1286 patients received cardiac surgery assisted by CPB from January 2017 to March 2019 were included in the study.The perioperative data and the peak serum total bilirubin at selected timepoints were recorded.Logistic regression of multi-factor analysis was used to define risk factors and then broken-line analysis was applied to predict the risky threshold.Results 312(24.26%)patients developed hyperbilirubinemia after surgery,with the in-hospital mortality rate up to 34.62%(108 cases).In those patients,valve surgery(45.51%,142/312),great vessel open surgery(37.82%,118/312)and heart transplantation(7.69%,24/312)were mostly performed.The duration of postoperative ICU stay and the use of ventilation were 6 days and 68 hours,which were significantly higher than those in non-hyperbilirubinemia group(P<0.01).Multivariate logistic regression showed that the postoperative ventilation time>49 h,the cardiopulmonary bypass(CPB)time>181 min and the abnormal preoperative liver function,use of intra-aortic balloon pump and extracorporeal membrane oxygen,unplanned re-exploration for bleeding were the risk factors for postoperative hyperbilirubinemia(P<0.01).The cutoff duration of postoperative mechanical ventilation and CPB affecting the incidence of hyperbilirubinemia,ICU days and in-hospital mortality were 120.21 h and 143.26 min,248.20 h and 239.51 min,259.50 h and 190.60 min,respectively.Conclusion Preoperative abnormal liver function,intraoperative CPB time,postoperative mechanical ventilation time,postoperative use of IABP or ECMO assistance,and unplanned secondary thoracotomy were high-risk factors for hyperbilirubinemia after CPB-assisted cardiovascular surgery.

关 键 词：体外循环 高胆红素血症 风险因素 阈值 

分 类 号：R654[医药卫生—外科学]