经食管超声监测体外循环心脏手术中门静脉血流量与术后肝损伤的相关性研究  

Study of the relationship between portal vein blood flow and postoperative liver injury by transesophageal ultrasound during cardiopulmonary bypass

作　　者：鲍道君 彭格红 陶文鸿 赵炳旭 BAO Daojun;PENG Gehong;TAO Wenhong;ZHAO Bingxu(Department of Ultrasound,Affiliated Hospital of Zunyi Medical University,Zunyi,Guizhou 563000,China)

机构地区：[1]遵义医科大学附属医院超声科,贵州遵义563000

出　　处：《医药前沿》2024年第25期1-6,共6页Journal of Frontiers of Medicine

摘　　要：目的:监测体外循环心脏手术中门静脉血流量(PVBF)变化,探讨PVBF与体外灌注流量及术后肝损伤的关系。方法:选取2022年8月—2023年8月在遵义医科大学附属医院行CPB心脏手术患者87例,利用经食管超声心动图(TEE)获得门静脉血流收缩期峰值流速(PSV)、舒张末流速(EDV)、阻力指数(RI)、搏动指数(PI)和时间平均峰值流速(TAPV),记录各时间点体外灌注流量(VPF)值并计算PVBF。同时收集术后肝功能生化指标:丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)、白蛋白(ALB)、胆碱酯酶(CHE)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT),探讨门静脉血流参数与肝功能变化的关系。将肝功能生化指标术前与术后以及体外灌注期间PVBF、VPF在肝功能正常组和异常组分别进行差异性比较,不同时间段门静脉参数、VPF进行重复测量方差分析,术后肝损伤危险因素采用回归分析,使用受试者工作特征曲线分析VPF对预测肝损伤的最佳截断值。结果:87例患者中术后出现肝损伤者75例,发生率为86.21%。术后第1、3、5天,肝损伤患者的AST、TBIL和DBIL高于术前,CHE和ALP低于术前,差异有统计学意义(P<0.05)。术后第5天,肝损伤患者的ALT高于术前,差异有统计学意义(P<0.05)。术后第1、3天,肝损伤患者的GGT低于术前;术后第5天,肝损伤患者的GGT高于术前,差异有统计学意义(P<0.05)。肝损伤患者术前术后的ALB比较,差异无统计学意义(P>0.05)。CPB期间,肝功能正常组的PVBF和VPF高于肝损伤组,差异有统计学意义(P<0.05)。CPB开始后,患者的PVBF均高于开胸前,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,CPB期间的PVBF值和升主动脉阻断时间是体外循环患者术后肝功能损伤的(P<0.05)。VPF的ROC曲线下面积(AUC)为0.752(P<0.05),临界值大于3.6 L/min。结论:当VPF大于3.6 L/min时,可能从一定程度上减轻术后肝损伤。PVBF�Objective To monitor the Changes of the portal vein blood flow(PVBF)during cardiopulmonary bypass cardiac surgery,and explore the relationship between PVBF,vitro perfusion flow,and postoperative liver injury.Methods A total of eightyseven adult patients who underwent bypass cardiac surgery in Affiliated Hospital of Zunyi Medical University from August 2022 to August 2023 were selected.Portal blood flow parameters,including peak systolic velocity(PSV),end-diastolic velocity(EDV),resistance index(RI),pulsatility index(PI),and time averaged peak velocity(TAPV),and vitro perfusion flow(VPF)values were recorded at each time point.The biochemical indexes of postoperative liver function were collected:alanine transaminase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL),albumin(ALB),cholinesterase(CHE),alkaline phosphatase(ALP),γ-glutamyl transpeptidase(GGT)to explore the relationship between portal blood flow parameters and changes in liver function.The biochemical parameters of preoperative liver function were compared with those of postoperative liver function and PVBF and VPF in normal and liver injury groups.Repeated measures ANOVA for portal parameters,VPF at different time periods.Risk factors for postoperative liver impairment were analyzed by regression analysis.The optimal cut-off value of VPF for prediction of liver function impairment was analyzed using subject characteristic curves.Results Among the 87 patients,75 had postoperative liver injury,with an incidence rate of 86.21%.On postoperative days 1,3 and 5,AST,TBIL and DBIL levels in patients with liver injury were higher than preoperative levels,while CHE and ALP levels were lower than preoperative levels,with statistically significant differences(P<0.05).On postoperative day 5,ALT levels in patients with liver injury were higher than preoperative levels,with statistically significant differences(P<0.05).On postoperative days 1 and 3,GGT levels in patients with liver injury were lower than preoperative levels;on postoper

关 键 词：体外循环 经食管超声 门静脉血流量 肝损伤 体外灌注量 

分 类 号：R541[医药卫生—心血管疾病]