CAJ | 학술논문

目的：探讨影响心脏外科术后高胆红素血症发生及其术前与术中危险因素。方法选择2012年1月至2012年5月期间在我科行择期心脏手术的成人患者168例，总结其人口学资料及相关的临床资料。以高胆红素血症组为研究组，非高胆红素血症组为对照组进行比较研究。结果本组168例中，术后发生高胆红素血症73例，发生率为43.4%。单因素分析提示，术前谷丙转氨酶水平、转肽酶、血清总胆红素、直接胆红素、间接胆红素，术前左房前后径、左室射血分数、二尖瓣与主动脉瓣狭窄的发生率、合并同期瓣膜手术、术中失血、术中输血输浆、手术及总麻醉时间是术后高胆红素血症的危险因素（P<0.05）。多因素分析提示，术前血清总胆红素水平（OR 1.440，95%CI 1.216~1.706，P=0.000）与手术时间（OR 5.745，95%CI 1.143~28.877，P=0.034）是术后高胆红素血症的独立危险因素。高胆红素血症组患者术后24 h引流量显著高于对照组，总呼吸机辅助时间、ICU时间以及术后总住院时间亦显著增加（P<0.05），但围手术期死亡率并未显著增加（P=0.974）。结论高胆红素血症在心脏外科术后发生率较高，术前血清总胆红素升高和手术时间的延长是术后高胆红素血症发生的独立危险因素，高胆红素血症的发生与术后机械通气时间、ICU时间以及术后总住院时间的延长显著相关。
목적：탐토영향심장외과술후고담홍소혈증발생급기술전여술중위험인소。방법선택2012년1월지2012년5월기간재아과행택기심장수술적성인환자168례，총결기인구학자료급상관적림상자료。이고담홍소혈증조위연구조，비고담홍소혈증조위대조조진행비교연구。결과본조168례중，술후발생고담홍소혈증73례，발생솔위43.4%。단인소분석제시，술전곡병전안매수평、전태매、혈청총담홍소、직접담홍소、간접담홍소，술전좌방전후경、좌실사혈분수、이첨판여주동맥판협착적발생솔、합병동기판막수술、술중실혈、술중수혈수장、수술급총마취시간시술후고담홍소혈증적위험인소（P<0.05）。다인소분석제시，술전혈청총담홍소수평（OR 1.440，95%CI 1.216~1.706，P=0.000）여수술시간（OR 5.745，95%CI 1.143~28.877，P=0.034）시술후고담홍소혈증적독립위험인소。고담홍소혈증조환자술후24 h인류량현저고우대조조，총호흡궤보조시간、ICU시간이급술후총주원시간역현저증가（P<0.05），단위수술기사망솔병미현저증가（P=0.974）。결론고담홍소혈증재심장외과술후발생솔교고，술전혈청총담홍소승고화수술시간적연장시술후고담홍소혈증발생적독립위험인소，고담홍소혈증적발생여술후궤계통기시간、ICU시간이급술후총주원시간적연장현저상관。
Objective To investigate the frequency, risk Factors, and prognosis of hyperbilirubinemia after cardiac surgery. Methods 168 patients who underwent elective cardiac surgery during 2012.1.1-2012.5.31 were included retro-spectively. Patients were divided into the experimental group with post-operative hyperbilirubinemia while others served as controls. Differences of the clinical data were compared between the two groups.And multivariable logistic regression modeling was used to identify the risk factors. Results Hyperbilirubinemia occurred in 43.4%(73/168) patients. The ex-perimental group had prolonged mechanical ventilation, ICU stay and post-operative hospital stays(P<0.05), but not sig-nificantly higher mortality(P = 0.974). There was significant difference between the two groups in preoperative ALT , GGT, serum total bilirubin, direct bilirubin, indirect bilirubin, left atrial diameter, left ventricular ejection fraction , mitral stenosis,arotic stenosis , combined valve surgery, intraoperatie blood loss, intraoperative transfusion of blood and plasma, operation duration and anesthesia duration (P<0.05). Preoperative serum total bilirubin(OR 1.440,95%CI 1.216-1.706, P=0.000),and operation duration(OR 5.745, 95%CI 1.143-28.877,P=0.034)were independent risk factors for post-op-erative hyperbilirubinemia in multivariable logistic regession analysis. Conclusion The frequency of post-operative hy-perbilirubinemia after cardiac surgrey is moderately high. Preoperative serum total bilirubin and operation duration are in-dependent risk factorsfor post-operative hyperbilirubinemia. Patients with hyperbilirubinemia have prolonged mechanical ventilation time, ICU stay and post-operative hospital stays.