CAJ | 학술논문

目的：观察体外循环心脏手术患者围手术期内肝功能的变化并对相关危险因素进行分析。 　　方法：比较108例体外循环心脏手术患者术前和术后第1、2、3、6天肝功能各指标的变化，并对相关危险因素进行单因素及多因素分析。 　　结果：与术前比较，(1)术后第1、2、3、6天的谷草转氨酶、直接胆红素均显著增高；血清白蛋白、胆碱酯酶显著性下降，血清总胆红素（不含第6天）均显著增高，碱性磷酸酶第1、2、3天显著性下降，第6天增高；(2)术后第1、2天，谷氨酰转肽酶较术前显著性降低，术后第6天显著性增高（；3）谷丙转氨酶在术后第6天较术前显著增高。差异均有统计学意义（P<0.05）。相关危险因素分析：单因素分析显示，心胸比≥0.56[P<0.05，优势比（OR）=2.900，95%可信区间（CI）：1.206~6.976]、心肺转流时间（P<0.05， OR=1.042，95%CI：1.017~1.068）、主动脉阻断时间（P<0.05， OR=1.041，95% CI：1.012~1.070)及术后第1天乳酸水平(P<0.05， OR=1.518，95% CI：1.182~1.948）与患者术后肝功能损害有关；多因素分析显示：心肺转流时间（P<0.05，OR=1.033，95% CI：1.007~1.059）及术后第1天乳酸水平（P<0.05，OR=1.340，95% CI：1.028~1.745）是体外循环心脏手术患者肝功能损害的独立危险因素。 　　结论：体外循环心脏手术后早期对多项肝功能指标产生影响；心肺转流时间及术后第1天乳酸水平是体外循环心脏手术患者围手术期肝功能损害的独立危险因素。
목적：관찰체외순배심장수술환자위수술기내간공능적변화병대상관위험인소진행분석。 　　방법：비교108례체외순배심장수술환자술전화술후제1、2、3、6천간공능각지표적변화，병대상관위험인소진행단인소급다인소분석。 　　결과：여술전비교，(1)술후제1、2、3、6천적곡초전안매、직접담홍소균현저증고；혈청백단백、담감지매현저성하강，혈청총담홍소（불함제6천）균현저증고，감성린산매제1、2、3천현저성하강，제6천증고；(2)술후제1、2천，곡안선전태매교술전현저성강저，술후제6천현저성증고（；3）곡병전안매재술후제6천교술전현저증고。차이균유통계학의의（P<0.05）。상관위험인소분석：단인소분석현시，심흉비≥0.56[P<0.05，우세비（OR）=2.900，95%가신구간（CI）：1.206~6.976]、심폐전류시간（P<0.05， OR=1.042，95%CI：1.017~1.068）、주동맥조단시간（P<0.05， OR=1.041，95% CI：1.012~1.070)급술후제1천유산수평(P<0.05， OR=1.518，95% CI：1.182~1.948）여환자술후간공능손해유관；다인소분석현시：심폐전류시간（P<0.05，OR=1.033，95% CI：1.007~1.059）급술후제1천유산수평（P<0.05，OR=1.340，95% CI：1.028~1.745）시체외순배심장수술환자간공능손해적독립위험인소。 　　결론：체외순배심장수술후조기대다항간공능지표산생영향；심폐전류시간급술후제1천유산수평시체외순배심장수술환자위수술기간공능손해적독립위험인소。
Objective: To observe the liver function changes and to analyze the risk factors in patients at peri-operative period of cardiopulmonary bypass surgery. Methods: A total of 108 patients with cardiopulmonary bypass surgery were observed for their liver function at prior and 1, 2, 3, 6 days post-operation, the related risk factors for lever damage were studied by uni- and multivariate regression analysis. Results: Compared with pre-operative indexes,① at 1, 2, 3 and 6 days post-operation, aspartate aminotransferase (AST), direct bilirubin (DBIL) were increased, serum albumin (ALB), cholinesterase (CHE) were decreased, and at 1, 2, 3 days post-operation, total bilirubin (TBIL) was increased, at 1, 2, 3 days post-operation, alkaline phosphatase (ALP) was decreased, while it increased at 6 days post-operation, allP<0.05;② glutamyl endopeptidase (GGT) was decreased at 1, 2 days post-operation, while it increased at 6 days post-operation,P<0.05;③glutamate pyruvate transaminase (GPT) was increased at 6 days after operation,P<0.05. Univariate regression analysis indicated that cardiothoracic ratio ≥ 0.56 (P<0.05, OR=2.900, 95% CI: 1.206~6.976), cardiopulmonary bypass time (P<0.05, OR=1.042, 95%CI: 1.017~1.068), aortic clamping time (P<0.05, OR=1.041, 95% CI: 1.012~1.070) and lactic acid level at 1 day after operation (P<0.05, OR=1.518, 95% CI: 1.182-1.948) were related to post-operative damage of liver function. Multivariate regression analysis presented that cardiopulmonary bypass time (P<0.05, OR=1.033, 95% CI: 1.007-1.059) and lactic acid level at 1 day after operation (P<0.05, OR=1.340, 95% CI: 1.028-1.745) were the independent risk factors for post-operative damage of liver function. Conclusion: Multiterm of liver function could be damaged at the early stage after cardiopulmonary bypass surgery; cardiopulmonary bypass time and lactic acid level at 1 day after operation were the independent risk factors for peri-operative damage of liver function in relevant patients.