心脏术后体外膜氧合缺血性肝炎发生及其危险因素研究  

The occurrence and risk factors of ischemic hepatitis in adult patients after cardiac surgery received extracorporeal membrane oxygenation support

作　　者：符鸿福 王妍[1] 王粮山 辛萌[1] 谢海秀[2] 田夏秋 郝星[2] 王红[1] 侯晓彤[2] Fu Hongfu;Wang Yan;Wang Liangshan;Xin Meng;Xie Haixiu;Tian Xiaqiu;Hao Xing;Wang Hong;Hou Xiaotong(Department of Extracorporeal Circulation,Center for Cardiac Intensive Care,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科危重症中心,北京100029 [2]首都医科大学附属北京安贞医院体外循环及机械循环辅助科,北京100029

出　　处：《中国体外循环杂志》2025年第1期23-28,35,共7页Chinese Journal of Extracorporeal Circulation

摘　　要：目的探究缺血性肝炎(IH)在心脏术后静脉-动脉体外膜氧合(V-A ECMO)支持患者中的发生率、预后及其相关危险因素。方法回顾性收集2018年1月至2023年11月北京安贞医院心脏术后使用V-A ECMO支持成人患者数据。按照有无IH发生分为IH组和对照组。采用生存分析评估IH对患者预后影响,LASSO回归筛选ECMO前IH发生相关变量,Logistic回归确定IH发生相关危险因素。结果最终纳入328例心脏术后V-A ECMO支持患者,其中104(31.7%)名患者发生IH。IH组患者死亡率明显高于对照组(75.0%比44.2%,P<0.001)。术前血红蛋白(OR=0.99,95%CI:0.98~1.00,P=0.046),主动脉钳夹时间(OR=1.00,95%CI:1.00~1.01,P=0.025),ECMO启动前乳酸(OR=1.14,95%CI:1.08~1.20,P<0.001)和序贯器官衰竭(SOFA)评分(OR=1.23,95%CI:1.06~1.43,P=0.005),为IH发生的独立危险因素。结论在接受V-A ECMO支持的心脏手术后患者中,IH是被低估的,并与不良预后密切相关。术前血红蛋白、主动脉钳夹时间、ECMO启动前乳酸和SOFA评分是IH发生危险因素。Objective To investigate the incidence,prognosis,and risk factors for ischemic hepatitis(IH)in adult patients received veno-arterial extracorporeal membrane oxygenation(V-A ECMO)assistance after cardiac surgery.Methods A retrospective analysis was conducted on adult patients receiving V-A ECMO support after cardiac surgery at Beijing Anzhen Hospital from January 2018 to November 2023.Patients were divided into the IH group and the control group(CG)according to the occurrence of IH.Survival analysis was used to assess the impact of IH on patient prognosis.LASSO regression was employed to screen for variables related to IH occurrence.Logistic regression was used to identify independent risk factors.Results A total of 328 patients were included,among whom 104(31.7%)developed IH.Mortality was significantly higher in the IH group compared to the CG(75.0%vs.44.2%,P<0.001).Preoperative hemoglobin(OR=0.99,95%CI:0.98-1.00,P=0.046),aortic cross-clamp time(OR=1.00,95%CI:1.00-1.01,P=0.025),lactate level(OR=1.14,95%CI:1.08-1.20,P<0.001)and sequential organ failure assessment(SOFA)score(OR=1.23,95%CI:1.06-1.43,P=0.005)prior to ECMO initiation were identified as risk factors for the occurrence of IH.Conclusion IH is an underrecognized condition in patients receiving V-A ECMO support after cardiac surgery and is strongly associated with poor prognosis.Preoperative hemoglobin,aortic cross-clamp time,lactate level and SOFA score prior to ECMO initiation are independent risk factors for IH.

关 键 词：缺血性肝炎 体外膜氧合 心脏术后 

分 类 号：R654.2[医药卫生—外科学]